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.

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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.

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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.

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