Reena Caprario is used to alarming symptoms. The 55-year-old mother of two was diagnosed with lung cancer in late 2023, and has a history of diabetes.
She had surgery to remove Stage I cancer in late 2023, and her diabetes was well managed, so Caprario didn’t think anything of it when she began experiencing back pain and acid reflux last May. A former smoker with a family history of heart disease, she knew she was at higher risk for cardiac conditions, but the discomfort felt similar to gastric symptoms she had had after her lung surgery.
For days, she dealt with the nagging pain. One day, she and her daughter went to the mall, and Caprario decided to run up and down the stairs to try and relieve the discomfort. On other days, she tried over-the-counter medications.
Then, after a week, the pain exploded, branching out into her neck, jaw and upper arm. It became so intense she said her hand started to go numb and her mouth felt like she had dozens of toothaches. The pain in her head was “excruciating.” Even as the pain shot down her arm and into her hand, Caprario refused to believe she was having a cardiac episode.
“Google became my doctor for a moment, and I was like ‘OK, I may have all these symptoms, but I’m just not having a heart attack,'” Caprario said. “I kept saying to myself ‘There’s no way.'”
Caprario went to her primary care physician, where an EKG showed abnormal cardiac activity. Her doctor wanted to call an ambulance to take Caprario to the nearest hospital, but she decided to have her husband drive her. When she arrived at AdventHealth Apopka, another EKG and blood work revealed that she had had a heart attack. More tests showed that her left circumflex artery “had a 99% blockage.” A piece of plaque that had built up in the artery had detached, blocking nearly all blood flow.
“They told my family I was lucky to be alive,” Caprario said.
Reena Caprario / AdventHealth
Unusual heart attack symptoms
The most important thing to understand about heart attacks, according to Dr. Harmony Reynolds, the director of the Sarah Ross Soter Center for Women’s Cardiovascular Research at NYU Langone Heart, is that “heart attack does not have to feel like it looks in the movies.” Ongoing pain like Caprario experienced isn’t unusual before a major cardiac event, said Reynolds, who was not involved in Caprario’s treatment. The early symptoms tend to be a warning that blood flow to the heart has become limited.
“The heart muscle will feel that, and it will send up a signal,” Reynolds said. “It might not even be painful. There might just be a sense of being uncomfortable, and that will usually localize to the chest, but it doesn’t have to.”
Pain “anywhere between the jaw and the belly button” could be a sign of a heart attack, Reynolds said, though usually chest pain is present. The level of pain can vary, but may be a sense of pressure or constriction. Other symptoms could include acid reflux, nausea, vomiting, shortness of breath, sweating, dizziness or lightheadedness, or a sense of impending doom.
Dr. Linus Wodi, the AdventHealth cardiologist who treated Caprario, said that the location of her artery blockage made the situation more complicated. The left circumflex artery, which connects to the important coronary artery, is around the back of the heart, making it harder to pick up with some tests. Severe blockages in this artery have a “high likelihood of fatality,” he said. If Caprario had waited much longer to seek medical care, she “may not have survived,” he said.
Treating a dangerous blockage
By the time Caprario arrived at the hospital, she only had about 1% blood flow through her artery, Wodi said. A blockage that severe can lead to an abnormal heart rhythm. It can also strain the heart, causing permanent damage to the muscle.
Wodi advised Caprario to undergo a percutaneous coronary intervention, where a thin tube is used to clear the blocked artery and a stent is placed to prevent another blockage. The procedure is done without anesthesia and usually lasts between 30 minutes and two hours.
The procedure went smoothly, Wodi said, and Caprario was released the next morning. She was put on several medications to reduce her risk of further heart disease, Wodi said and was referred to a 12-week cardiac rehabilitation program. Caprario said she worked with a nurse to exercise more regularly and make other heart-healthy lifestyle changes.
Reena Caprario / AdventHealth
Now, several months from the event, Caprario said she feels better than ever. In addition to working on her heart health, she is focused on spending time with her family and returning to the athletic activities she once enjoyed.
“I don’t even feel like I had a heart attack,” she said.