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Fit, Slim, Non-Smoker, Vegetarian And Just 39 Years Old - Mother-of-Two's Undiagnosed Heart Disease Could Have Cost Her Life

Sherman Oaks, July 8, 2006 - Fit, slim, a non-smoker and vegetarian, Lori Kupetz seemed an unlikely candidate for heart disease—a fact that nearly cost her life.  The Sherman Oaks, CA, mother of two is recovering from triple bypass surgery at the improbable age of 39.

Despite the young woman’s escalating chest pain, a litany of doctors dismissed the possibility of coronary artery disease after a standard stress test proved negative. They were wrong.

“I’ve learned you have to be a very strong advocate for yourself,” says Kupetz of her frustration-fraught experiences. “Doctors are amazing people, but they are people. They aren’t always right.”

One doctor finally did get it right. An expert in women’s health and heart disease at Cedars-Sinai Medical Center, C. Noel Bairey Merz, M.D., took Kupetz and her symptoms to heart, and put her on the path to recovery—just in time.

“I feel blessed, really fortunate that I found Dr. Bairey Merz and got the help I needed” Kupetz says. “Just because I didn’t ‘fit the bill’ for heart disease, I could have died.”

Kupetz’s symptoms began more than a year ago, in February 2005.

“I was hiking with a friend and got terrible chest pains,” she recalls. “Then it happened a couple of more times and I thought, “aha,” something’s not right and called my internist.”

In the back of her mind was a troubling family history of heart disease in both sets of grandparents and included heart attacks, bypass surgeries and premature death. Her own mother and father had long battled high cholesterol, and Kupetz, her brother and sister were plagued by the same problem.

Kupetz’s internist sent her to a cardiologist, who reviewed her family history and ordered a stress test. On the treadmill, Lori experienced the same symptoms. “I’m having the pain right now,” she told him.

The results of the treadmill were normal, the cardiologist informed her, and, given her youth, gender and general “good health,” he ruled out heart disease.

“He told me, ‘You’re barking up the wrong tree,’ and sent me to a gastroenterologist,” explains Kupetz.

All the while, her symptoms were worsening. Now, simply bringing in the groceries, walking up a flight of stairs or taking the kids to the park brought on chest pain.

“The pain was really affecting my quality of life,” she remembers.
She completed a series of sophisticated tests to evaluate her esophageal function, then considered the possible culprit behind her chest pain. Again, they proved negative. Next, her doctor ordered a CT scan to rule out cancer. “That really scared me,” Kupetz recalls.

But, once more, results showed nothing wrong. All the while, Kupetz’ episodes of chest pain were becoming more frequent, more painful and were occurring with less exertion. Still stumped by her symptoms, the gastroenterologist suggested treating her pain with low doses of antidepressants and seizure medications.

“I was extremely frustrated and not well,” she remembers. “I felt like giving up and seeing if the pain would just eventually go away.”

When she spoke to a doctor friend, he advised her, “Lori, you’ve got to get your heart checked.”

As chance would have it, the next day, Feb. 1—the start of Women’s Health Awareness Month—she read a story in The Los Angeles Times about research conducted by Bairey Merz on undiagnosed heart disease in women. The article explained that standard tests used to evaluate male patients were often ineffective in identifying coronary artery disease in women

Coincidentally, two friends called her with the same information gleaned from articles they had read in the Wall Street Journal and Woman’s Day magazine – both of which quoted Bairey Merz, medical director of Cedar-Sinai’s Women's Health Program and Preventive and Rehabilitative Cardiac Center.

“Instinctively, I knew I had to call her, that I needed to see her,” says Kupetz, who phoned Bairey Merz’ office that day and left a message explaining her situation. “She called me back immediately.”

After months of frustration and worry, Kupetz finally felt a sense of relief when she met with Bairey Merz.  “She listens, and she’s kind, brilliant, caring.”  

Bairey Merz ordered an echo cardiac stress test and adenosine cardiac stress MRI, a study using medication to simulate exercise-induced stress on the heart. Both showed Kupetz’s heart was not responding as it should and, says Lori, suggested the possibility of small vessel disease, obstruction of a major artery or a congenital defect.

A subsequent angiogram found three arteries with major blockages, with the left anterior descending coronary artery completely occluded at its origin. Angioplasty to open it was attempted without success, and Kupetz was scheduled for a triple bypass the next morning. On March 17, Kupetz underwent the open-chest procedure, performed by Robert Kass, M.D., surgical director of Cedars-Sinai’s Heart Transplant Program, and then spent two days in ICU and another few days recuperating in a hospital room.

Now, three months later, Kupetz is on the mend...and very grateful.

“My friends and family mobilized around me to take care of things,” says Kupetz, who admits to feeling vulnerable and a little fragile now. “Going through something like this really shakes your confidence, especially after being told you’re okay for so long.”

Bairey Merz will continue to monitor her health, which Kupetz helps maintain with a regimen of statin drugs, beta blockers, aspirin and prescribed doses of fish oil. Her angina, triggered by insufficient blood flow to her heart, is finally gone.

“For the rest of my life I’ll have to think about my health,” she acknowledges. “There’ll be more dietary changes, exercise five days a week, medications and follow up tests.”

Not that she minds. “I hear and read stories now about other women, like a 42-year-old who dropped dead in her kitchen. I’m so grateful it’s not me.”

Kupetz will be especially watchful over her own children, given what she knows now. Though understandably frightened by their mother’s illness, the girls, ages 6 and 9, have already put the experience in  perspective.

As Kupetz struggled to find a shirt to cover her collarbone-high incision, her youngest daughter interposed, “Every scar has a story, and you should be proud of yours.”