Woman, 51, has 5 heart attacks in 16 months, asks 'what's wrong with me?'

MUMBAI: A single episode of heart attack sounds scary enough, but a 51-year-old Mulund resident has lived through five heart attacks in the past 16 months.
She's had five stents fitted, has undergone six angioplasties and one cardiac bypass surgery.

Rekha (her name changed), who was last wheeled into the cath lab on December 1 and 2, said, "I only want to know what is wrong with me and whether I will develop a fresh blockage three months down the line."
Her first heart attack took place on a train while returning to Borivli from Jaipur in September 2022 and she was taken to a public hospital in Ahmedabad by the railway authorities.
"We preferred to rush to Mumbai for an angioplasty," she told TOI from her twin-sharing room in Fortis Hospital, Mulund.

"The trigger for Rekha's heart problems remains a mystery," said Dr Hasmukh Ravat, who has been her cardiologist since July after she had undergone 2 angioplasties and the bypass surgery.
Experts, including multiple doctors she has consulted, believe an auto-immune disease such as vasculitis in which blood vessels get inflamed and narrow could be the cause, but test results have so far not shown any clear diagnosis.
Every few months, the tell-tale symptoms of heart attack return: sharp pain in the chest, burping and uneasiness.
"I have had heart attacks in February, May, July and November," she said, adding that there was another incident when she rushed to a hospital in panic fearing another attack.

Rekha has other chronic issues such as diabetes, high cholesterol and obesity; she weighed 107 kg in September 2022, and has lost over 30kg since. She has been given injections of 'PCSK9 inhibitor', a relatively new cholesterol-lowering drug that has kept her levels low, and her sugar too is under control, but the heart attacks continue.
Dr Ravat said while it's not unknown for patients to develop recurrent blockages at the same spot, Rekha develops new blockages at different spots.
"Her first attack was caused by a 90% blockage in the left anterior descending artery and it was a 99% blockage in the right coronary artery the next time," he said.

She once developed a complex lesion at a trifurcation of main arteries. As Rekha had multiple punctures in her femoral artery by then, Dr Ravat had to tackle this tricky junction through her hand (left radial artery).
Rekha prays the cath lab procedures on December 1 and 2 mark the end of her hospital visits. "Doctors have started me on steroids and a new set of medicines that will hopefully help," she said.
Medically speaking, Rekha has been lucky because her heart attacks have been NSTEMI or non-ST-elevation myocardial infarction that occur when the heart's need for oxygen cannot be met.
"STEMI heart attacks are dangerous in comparison. Despite the various eight procedures, her heart's ejection fraction is 45% which is good," added Dr Ravat.
When contacted, KEM Hospital's cardiology department head , Dr Ajay Mahajan, said such "malignant atherosclerosis (hardening of arteries)" is rare. Doctors have kept her lipids down for months, she has had stenting and bypass, yet the problem recurs.
"It could hence be a rare auto-immune condition at work," added Dr Mahajan.