Grave uncertainty Overlooked cardiac blockages led to alarming brush with death, point to medical inequities endangering women’s heart health By: AV Kitching Posted: 2:01 AM CDT Tuesday, May. 23, 2023

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This article was published 23/05/2023 (838 days ago), so information in it may no longer be current.

At first doctors told Michelle Logeot she was dealing with menopause. One thought she had a cold. One told her it was the flu. A third reckoned it was kidney stones.

The ex-smoker was told she had asthma and shunted off with a prescription for prednisone, medication used in severe attacks to reverse the swelling of airwaves.

Another doctor accused her of lying after her heart stress tests results came back fine.

They were all wrong.

Not one medical professional realized the problem was with Logeot’s heart: she had a 90 per cent blockage in the major artery known as the “widow maker,” as well as blockages in eight other blood vessels surrounding her heart.

Logeot wasn’t taken seriously until June 26, 2017, the week she turned 51, when she had a heart attack that triggered cardiac arrest.

She was effectively dead for three minutes.

“I felt like I had done everything I could to see what was going on, but I was being dismissed,” she says. “They wouldn’t listen to me until I flatlined.”

Logeot’s symptoms started six months prior to her attack. She felt weak, she was sweating more than usual and had fainted a number of times.

As the director of regional centres for University College of the North in Thompson she was often away from home, travelling to other northern Manitoba communities.

Before her heart attack she made multiple visits to her GP and to separate emergency rooms in Thompson, Flin Flon and Swan River, but her fears were brushed off. Some hospital staff assumed she was after pain medication because she had visited different ERs several times.

“I felt like I had done everything I could to see what was going on, but I was being dismissed… They wouldn’t listen to me until I flatlined.”–Michelle Logeot

Logeot says she was misdiagnosed up to 10 times.

“They made it about my mental health. They said I had a prolapsed vagina, kidney stones, shingles,” she says. “Once they didn’t even listen to my chest and told me I had the flu.”

Her family history should have alerted medical professionals to investigate, she says.

Logeot’s maternal grandfather had a STEMI (ST elevation myocardial infarction), a heart attack with a completely blocked coronary artery. He died at 63.

At 57, her paternal grandmother suffered a fatal heart attack.

And, by the time he was 46, Logeot’s father had had five bypasses.

“There is a lot of family history, which everyone knew about, but they still didn’t take me seriously,” Logeot says.

When she came to in the hospital, after the emergency team used a defibrillator to restart her heart, it took her some time to accept what had happened.

“Because they had been telling me that I was OK, constantly telling me that there was nothing wrong with me, I had believed them,” she says. “It took my brain a while to work around that.”

“Because they had been telling me that I was OK, constantly telling me that there was nothing wrong with me, I had believed them.”–Michelle Logeot

When she was discharged a few days later, she was angry. She believes she was dismissed because of her gender, because women’s symptoms present differently than men’s.

Dr. Mahwash Saeed, assistant professor of medicine at the University of Manitoba, says that while the most common sign of a heart attack in both men and women is chest pain and discomfort, women can experience a heart attack without chest pressure.

And while medical professionals have an “amazing cardiovascular curriculum,” there is not yet a dedicated section for women’s symptoms.

“Women have arm pain, jaw pain, shortness of breath, vomiting… we have not been aware of these symptoms, both in the community and in the medical system, until recent years,” Saeed says.

Pregnant women, for instance, are at a higher risk of experiencing spontaneous coronary artery defection — a rip to their artery wall — which occurs around the time of childbearing and puerperium (approximately six weeks after childbirth).

“This heart attack, which can present while you are pregnant, during delivery and after delivery, is a completely different kind of heart attack. It is not caused by a clot or by fat in the heart vessels,” Saeed explains.

She says public awareness of the lesser-known symptoms in women should be a priority — and advocating for yourself, if you feel there is something wrong — is of the utmost importance.

“Don’t be afraid of becoming a nuisance. If something is not right, keep going back to your primary care provider, keep going to the emergency room as needed; give people a chance to get it right.”

Logeot says there is a fine line to walk when tackling the medical system.

“If you come across as an angry person, they don’t want to deal with you; they just shut you down. You have to manoeuvre through our medical system. Be firm but as unemotional as you can, ” she advises. “If you show anger or if you are too aggressive, they will try to make it about mental health. You have to get your point across. You have to walk in and be strong enough to say, ‘Hey, I don’t agree with your diagnosis — can we look at something else?’

“Don’t take no for an answer.”

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Logeot works with Heart and Stroke Canada to increase awareness of the inequities within the medical system that put women’s heart health at risk. She says her advocacy work with them, and her involvement with Facebook group Canadian Women with Medical Heart Issues, has given her a purpose.

The group was started by Winnipegger Jackie Ratz, 54, after she was diagnosed with chemo-induced cardiomyopathy at 44, which evolved into heart failure when she was 47. Ratz has a Cardiac Resynchronization Therapy (CRT) device implanted, which is working together with seven different medications to keep her heart function stable.

“After I was diagnosed, I went looking for options for support from other women who are facing diagnoses of heart failure or disease,” Ratz says. “I didn’t find anything, so I started the group. We have close to 1,100 members now.”

The group is a safe space for women to ask questions and share experiences. Members don’t seek medical advice from each other — anyone with a medical query is directed to official avenues — but they do talk about mental-health struggles and how to maintain a positive outlook. They exchange news of novel medications, different procedures and advancements in the field.

“Our group offers perspective,” Ratz says. “Sometimes knowing that you are not alone, that you are not crazy for feeling certain things, is very helpful. As women, we communicate differently when we are women together. As women we know we can get misdiagnosed when it comes to the heart and the gender bias that exists out there.

“It’s remarkable the connection you make. We talk about certain barriers to our career and to our health. The group has evolved in such a way it gives me more than I could have ever hoped for. Outside of family, there is no bond greater than women coming together with other women.”

“After I was diagnosed, I went looking for options for support from other women who are facing diagnoses of heart failure or disease… I didn’t find anything, so I started the group.”–Jackie Ratz

For Logeot, the impact of her heart attack is far-reaching. She has Class 2 heart failure; she hasn’t been able to return to work and has mild brain damage that affects her memory.

She says she isn’t the woman she used to be.

“I have changed very much. I have so many more limitations,” she says. “I was really outgoing; now I don’t go out. My life is a shell of what it was. I was busy travelling all the time and now I am very much a recluse.”

Her mental health has been especially affected; she now has depression and anxiety.

“For a lot of people, mental health is the hardest thing to talk about,” she says. “When I told my GP, ‘I am really depressed and struggling,’ he told me to relax and learn how to get over things.”

“When I told my GP, ‘I am really depressed and struggling,’ he told me to relax and learn how to get over things.”–Michelle Logeot

She has mixed feelings about the medical system that failed her, and sought answers from the doctor who accused her of lying.

“I confronted him and he said ‘I am so sorry.’ He didn’t have a defensive attitude, he wasn’t aggressive… that helped a lot with the anger,” she says. “It is so complicated that the people who just about killed me also saved my life.”

She hopes what she went through wasn’t in vain, that her experience will help give other women the confidence to speak up for themselves.

“I hope my story helps someone else. I hope it helps women advocate for themselves if they are dismissed like so many of us have been,” she says.

av.kitching@winnipegfreepress.com