Medical Mysteries: Her maddening cough had an unexpected cause - WaPo

[question everything]

Constance Meyer’s hacking cough was driving other people crazy. For more than a year, it had been the soundtrack of her life, disrupting the violin lessons she was giving, waking her up at night and irritating family and friends who were baffled by its imperviousness to multiple treatments.

Meyer’s own doctors couldn’t agree on a cause. One attributed her chronic cough to asthma. Another implicated her age, then 71. A third blamed acid reflux. It wasn’t until the mother of a new student delved more deeply into her symptoms and medical history that the cause was unmasked — intervention that may have saved Meyer’s life.

(snip)

Kamath said her concern was fueled by her suspicion that Meyer’s cough didn’t stem from asthma or lung disease but was a cardiac cough, the sign of a potentially serious heart problem. Meyer’s CT scan and family history indicated she was at risk. Kamath spoke to a colleague who agreed to see Meyer sooner. The cardiologist ordered a stress echocardiogram, a test performed while walking or running on a treadmill. Unlike a standard echocardiogram, it assesses how the heart performs during exercise.

(snip)

The angiogram revealed a severe blockage — estimated at 90 to 99 percent — of Meyer’s left anterior descending artery (LAD), which supplies about half of the blood to the heart. Her other arteries were clear. A severe blockage of the LAD can cause a heart attack known as the “widowmaker” because of its high fatality rate. The survival rate for a widowmaker that occurs outside a hospital or similar facility is only about 12 percent. And despite its name, widowmakers affect women.

One of the most common symptoms of a blocked artery is angina or chest pain. But Meyer had none. “Her dry cough was her anginal equivalent,” Kamath said. “Constance was a ticking time bomb. She could have just dropped dead suddenly.” Meyer was scheduled for an angioplasty, a procedure to open the blocked artery and place inside a tiny metal coil called a stent to keep it open. The night before the Sept. 17 procedure, Kamath called to wish her well and offer some advice: If Meyer’s cough got worse or if she experienced any symptoms such as chest pain, she was to go to the ER immediately.

https://archive.ph/LN4vp#selection-224.0-224.1

[biophile]

1. This was one of my husband's biggest warning signs as well

He also had shortness of breath and fatigue. He went to the doctor thinking it was his lungs (which were also compromised) and in the work up, discovered a completely blocked LAD artery. However it also found pulmonary fibrosis of his lungs. The heart cath and bypass had to come first before addressing his lungs condition.
One thing I learned in 43 years in medicine- it’s almost never just one thing! Usually by the time you’ve discovered one problem, there’s something else going on. 😏

[question everything]

2. Certainly as you are getting older. This woman is 71 years old

[hlthe2b]

3. It is unbelievable that her physicians did not work her up for potential cardiac dysfunction when the cough persisted

and even worsened--despite all the usual symptomatic treatments. Damn. Your veterinarian would have performed or ordered radiographs- at a minimum- and seen at least some evidence to support the former and rule out the earlier assumptions. With those findings, her physicians would then have been expected to order that MRI, echo, and perhaps some other imaging studies. I strongly suspect had she been male they would NOT have ignored her continuing/worsening symptoms. As much as the literature has stressed the symptoms of cardiac insufficiency and MI in women, they still tend to be ignored--that "protective estrogen effect" ya know.

Now with this administration and HHS (under RFK JR) determination not to include women, race, or any other variable long shown to present differently for many syndromes OR at greater risk in any targeted interventions or study, women like her will fall through the cracks even more.

No. I do not consider this a medical mystery. More like medical malpractice!

[question everything]

4. Some explanations (from the story)

Why did multiple doctors fail to suspect a heart problem?

“Women can present very differently than the arm numbness, chest pain, elephant-sitting-on-the-chest” feelings described by men, Kamath noted. Too often, she added, their symptoms “are dismissed or not even looked into.”

The time pressures under which doctors operate, the cardiologist said, may have been a factor. “It took me sitting down with her for a while to make me think this was cardiac,” Kamath said. “That may not have been the case if somebody had 10 minutes” for an appointment.

Anchoring bias, a common cause of medical errors in which doctors focus on a single piece of information early in the process without considering subsequent data, may have played a role.

Then there’s the possible role of telemedicine, which can impede close observation, an essential clinical tool. The pulmonologist never saw Meyer in person — every appointment was virtual.
Kamath said she tells her patients “there’s nothing that will replace a good physical exam, and that’s why they have to come in.”

[hlthe2b]

5. Absolutely summarizes my very points: Medical Malpractice, Wanton Ignorance, and Systemic Misogyny.