Identical twins Mairéad Lyons and Thérèse Walsh have always had a very close bond but it reached a new level when both of them suffered heart attacks in their 30s, within eight months of each other.
“It’s the most twin thing we’ve ever done,” says Thérèse, now aged 39, who is the younger, “by five minutes”, of the pair.
Sitting in the front room of Thérèse’s home in Rathangan, Co Kildare, they both turn their wrists to show matching tiny scars where a thin tube used for coronary angiograms was inserted.
The circumstances and symptoms of their heart attacks were different but they each had a relatively rare spontaneous coronary artery dissection (Scad). It’s an under-diagnosed, emergency heart condition, where a tear occurs in the artery wall, and which primarily affects women.
RM Block
Symptoms of Scad are similar to those of other heart attacks, as all are due to lack of blood supply to the heart muscle, whatever the cause, says Dr Angie Brown, consultant cardiologist and medical director of the Irish Heart Foundation. Most patients present with chest pain or pain radiating to the arms or neck, nausea, vomiting, breathlessness; some may have palpitations and dizziness.
[ Heart attacks in women: ‘I really had no idea I was having one’Opens in new window ]
For Mairéad, it was a near-death experience. In the aftermath of a second heart attack that happened during a hospital procedure, she saw her father, John Lyons, who had died of cancer a year previously. He asked her if she was coming.
“That was a very scary moment. I genuinely thought I was fine up until then.”
Scad and the repercussions have been more severe for Mairéad. However, Thérèse has no doubt that she and healthcare staff reacted quicker to the warning signs she had, thanks to her twin’s experience.
There’s a twist in the tale of Thérèse’s health after that – but let’s start with Mairéad’s story.
In the autumn of 2023, she and her partner, Pat Grogan, had been living in Trim, Co Meath, for more than a year, having moved there when their daughter Eleanor was just a month old. Back in her IT consultant job after maternity leave, Mairéad was trying to regain fitness through 5am gym sessions with a personal trainer. It was during one of those early-morning workouts that she started getting a “weird pain” in her chest.
“I thought I’d probably pulled something doing a pull-up or whatever.”
She abandoned the session and went to start work early at home. Not feeling great, she took a painkiller, with every intention of powering through. But her sense of being unwell persisted and, after telling her partner and ringing her mother Sheila, a nurse, an ambulance was called.
The paramedics did various tests at the house and could not find anything suspicious, but decided to bring her into hospital. By then, Mairéad, having taken aspirin, was feeling fine and worrying that she was making a big deal out of nothing.
However, blood tests at Blanchardstown hospital showed she had had a heart attack. What’s more, levels of the protein troponin, which indicate heart damage, were rising, suggesting further harm was being done. She was admitted for the weekend, and transferred to the Mater private hospital on the Monday for an angiogram. As that procedure was being done, a second dissection started.
[ Heart disease in women: ‘I was so shocked by news of my artery blockage’Opens in new window ]
“They could see it happening in real time,” says Mairéad. “I was awake through the whole thing and I just remember them walking away for 10 minutes while I was on the table because, if they moved or did anything with me, it would have worsened.”
The necessary equipment was at hand were she to go into cardiac arrest. “I was in a lot of pain and I was traumatised.”
Later, after being wheeled to the cardiac unit where she drifted in and out of sleep, “I started getting this intense pain in my chest again”. She is not sure if it was another heart attack, “but it felt like one. And they started giving me pain meds. “That was probably the scariest night I’ve had with it. Lots of doctors around me.”
It was then that she had the vision of her father. She spent about 10 more days in hospital. “As soon as I could go up and down a flight of stairs without breathlessness I was good to go.”
But it was still not known what had caused the initial Scad and whether or not it might happen again.
After a scare some weeks later, with chest pain and low blood pressure, she was offered cardiac rehabilitation. But at the assessment she did not fit the criteria for the programme, and was told she seemed to have her health under control. “I just had to figure it out on my own,” says Mairéad, who turned to the Irish Heart Foundation for support and to inform herself. This, she believes, is the big difference between her experience of Scad and Thérèse’s.
“I’ve had to find the support myself and I’ve had to go off and learn things and get more comfortable and confident with my body because, essentially, my body failed me. I was living with the lasting effects of the damage that was done to my heart.”
Her employer, Alltech, in Dunboyne, Co Meath, has been amazingly supportive, she says. “That makes a huge difference. I felt ready to go back after about 10 or 11 weeks on my own terms. And they continue to support me if I am feeling off.”
Two years on, she is back at work full-time and “living a relatively normal” life but no longer goes to the gym, as intense exercise is to be avoided. She sticks to walking and Pilates. Routine healthcare has become a lot more complicated because even her dentist has to consult a cardiologist before any treatment.
“There are certain things that I can’t do. Such as, I can’t have any more children, which sucks because we had just started having that conversation before my heart attack.”
Thérèse was in the midst of fertility treatment when she had her Scad heart attack. “I wasn’t a health freak,” she says, in teasing reference to Mairéad’s gym sessions. Thérèse was just sitting down having a cup of tea late one afternoon in May 2024 when a wave of nausea swept over her. Initially, she put it down to not having eaten.
“My right arm felt a bit funny. I was like, ‘Oh, it’s probably just muscular. It’s grand. I’m sure I’m fine.’ So I just went to lie down for a couple hours.” However, feeling no better when she woke, she rang the out-of-hours KDoc service. Without Mairéad’s experience, she believes she would not have made that call.
An ECG at KDoc that evening detected abnormalities and she was sent to Tallaght University Hospital, with a letter mentioning the family history of Scad, which ensured she was not left waiting. “I was triaged pretty quickly. About 1am then, they came in to say: ‘You’ve had a heart attack.’ I freaked out.”
Her situation was further complicated by a false positive pregnancy test at the hospital, due to the ovulation stimulation treatment she was undergoing. “So they were treating me as if I was pregnant and they thought that’s what had caused the heart attack.”
Although she was pretty sure the positive test was due to the last hormone injection she had taken, medical staff could not take any risks. It meant she had to have a catheter angiogram without any sedation. “It was horrendous – and they didn’t tell me until I was there on the table.”
It confirmed she had had a Scad but a different type to Mairéad’s, a narrowing rather than a tear, and it was in her right coronary artery, while her sister’s had been on the left.
Thérèse was told nothing could be done at that time; they wanted to see if the Scad would heal and, in the meantime, they would learn if she really was pregnant. She wasn’t and had made a good recovery by the time she had a repeat angiogram about two months later, “thankfully sedated”.
But that September she had another event – not a heart attack, but her troponin levels were raised. A CT (non-invasive) angiogram showed no damage had been done but she was advised not to go through any more fertility treatments.
It was an extremely hard recommendation for Thérèse and her husband, Seán Walsh, to hear, as they had been trying for a baby for almost eight years. They were about to move on to IVF, having had no success with ovulation stimulation.
But the couple accepted the guidance, resolving to be “the eccentric aunt and uncle” instead. “Then, complete surprise … Jack,” she says, looking down lovingly at the three-month-old baby sleeping on her chest. In November last year, six months after her heart attack, she found out she was pregnant.
It turned out to be a “dream pregnancy”, says Thérèse, who booked into the Rotunda Private under Dr Jennifer Donnelly, a specialist in high-risk obstetric care. “She kept me well informed about the risks because it was very likely to happen again. It’s still very likely to happen now.” Post-partum is a common time for Scad to occur.
“So there is still that fear there but I’ve recovered really well.”
She had to have a C-section because a natural delivery would potentially increase the risk of another heart attack.
During her pregnancy, Thérèse did manage to get on a cardiac rehabilitation programme, in Tallaght. She made sure to push for it, having seen how Mairéad missed out. “I knew that anything to help decrease the risk, like rehab, would mean a better pregnancy overall and better health for myself.”
Cardiac rehabilitation with psychosocial counselling would be recommend for patients after Scad, says Brown. Ongoing medical management would usually include aspirin and beta blockers, with other medication as needed. Hormonal therapy should be avoided and patients are advised about reducing potential triggers, such as lifting heavy weights, and reducing emotional stress.
“Women of child-bearing age may be advised to avoid future pregnancy due to the risk of recurrent Scad,” she explains. High progesterone levels may weaken the arterial wall and oestrogen can lead to excessive blood clotting, increasing the risk of Scad and thrombosis.
With the true incidence of Scad unknown because it continues to be missed, it is important, says Brown, “that this condition is considered in the differential diagnosis of women, particularly young to middle-aged women who present to the ED with an MI [myocardial infarction, ie heart attack]”.
Mairéad says the whole experience has given her a completely different perspective on life. (And, not surprisingly, the twins’ three younger siblings have all gone for health heart checks since.) “I used to be a really big stress freak. I used to be big on control all the time. Everything was routine. Even my work has commented on how much calmer I am as a person because, like, the world isn’t going to end because I didn’t do any [one] thing.”
Thérèse reckons she has more “medical anxiety” now but is calmer in other respects. “You’re kind of wondering when is it going to happen again? It’s not fear but an extra level of consciousness and awareness that you have to attach to who you are now.”
Everyone around them worries too, points out Mairéad, but she clearly does not like to be regarded as “fragile”. Her “clapback” to anybody annoyingly admonishing her for not taking it easy is “you could be hit by a bus tomorrow”. Life is full of risks. “I don’t want to be living my life in a bubble wrap,” agrees Thérèse, who is on maternity leave from her recruitment job with Microsoft.
Going into this interview to raise awareness of Scad, they wondered what they would have to say, apart from, “we both had heart attacks and we’re grand now”.
More than an hour and a quarter later, after humorously sharing and emotionally reliving moments of their ordeals, while also stressing the importance of women listening to their bodies and advocating for themselves, they chirpily conclude: “Sure, we’re grand now.” But their lives have changed forever, together.
Heart disease: Tips to minimise risk
Coronary disease due to atherosclerosis, which causes furring up of the arteries, has a slow onset, unlike spontaneous coronary artery dissection, which is an acute event. To reduce the risk of heart disease, consultant cardiologist and Irish Heart Foundation medical director Dr Angie Brown, recommends:
- Get your blood pressure checked and have it treated if high.
- If you smoke, stop smoking because it significantly increases the risk of a heart attack, as well as lung disease and cancer.
- Get your blood glucose and cholesterol checked and, if necessary, treated.
- Take regular exercise, which can improve blood pressure control, reduce stress, improve sleep, as well as help keep a healthy weight, along with a well-balanced diet.
- Cut down on alcohol as this can increase blood pressure and contribute to weight gain.
For further information on heart health see the Irish Heart Foundation website irishheart.ie. Or for Scad support, talk to one of the IHF nurses on the support line: (01) 668 5001.
The Irish Heart Foundation’s Her Heart Matters campaign, supported by the Department of Health Women’s Health Fund and the HSE, empowers women to take control of their heart health and reduce their risk of cardiovascular disease. The charity has a 28-day planner of heart-healthy habits, including nutrition and physical activity tips, in addition to information on the symptoms of heart disease and stroke at irishheart.ie
