Heart disease is the leading cause of death in the U.S. But it's easy to think it won't affect you if you’re young, eat well, and exercise often. That’s what Kristie Elfering, who has been an avid runner for years, thought—and she ended up having a heart attack during the TCS New York City Marathon.
The 41-year-old Minnesota resident tells SELF that she “always ran as a form of exercise” but started actively competing in races and triathlons in 2010. Since then, she’s done an Ironman race, a 100-mile trail run, and even competed in the USA Triathlon National Championships several times. Elfering’s father died of a heart attack at age 51, and both of her father’s parents died from heart attacks. “However, I never had any symptoms or indication that I had a heart issue that I should be aware of at this age,” she says. “I also thought that since my diet and level of exercise were higher than my grandparents, I had nothing to worry about.”
That all changed in November during the New York City marathon, around mile 15.
Elfering says her marathon started out as usual but “during mile 15, I found myself thinking that I was hot,” she says. “Then, as my friend and I crossed the Queensboro Bridge, I looked at my watch and was surprised to see that the last mile had been at a slower pace than the other miles. After that I don’t remember anything until waking up in the hospital.”
Her friend told her later that it looked like she bent over to tie her shoe. But when she realized Elfering had collapsed, she called for help. Ted Strange, M.D., a geriatric physician in New York, happened to be running by at that moment and stopped. Dr. Strange later told CBS News that Elfering didn’t have a pulse, so he began administering CPR and called for a defibrillator, a machine that helps deliver electrical current to the heart to try to correct a heartbeat or jumpstart the heart. Paramedics and members of the FDNY came to help, and it took four tries with the defibrillator to resuscitate Elfering.
Elfering doesn't remember there being any other clues that something was going to happen ahead of time. “I only remember thinking that our pace had slowed down,” she says.
Elfering woke up in the hospital and spent four days in the coronary care unit (CCU) before she was discharged. But she would be back again in a few days.
Her doctors wanted her to spend another week in New York before clearing her to fly home, and they sent her home in a portable defibrillator. “I left feeling great and was even out at museums and seeing other tourist attractions,” she says. But days later, in the car, she had a second cardiac event. “The defibrillator saved my life for a second time,” she says. “The portable defibrillator shocked me a number of times and kept my heart going until the ambulance came.” She was taken to the hospital again, where she stayed for nine days.
During that stay, doctors implanted an internal defibrillator, called an implantable cardioverter defibrillator (ICD), which is a battery-operated device that connects to the heart. If a patient has an abnormal heart rhythm, the ICD device will deliver an electric shock to restore a normal heartbeat, per the American Heart Association.
It’s terrifying to think that an otherwise healthy person can have a heart attack, seemingly out of nowhere, but these situations do happen.
There are a few reasons why a seemingly unexpected cardiac event can occur, Jennifer Haythe, M.D., co-director of the Women's Center for Cardiovascular Health at Columbia University Irving Medical Center and cardiologist at NewYork-Presbyterian/Columbia, tells SELF. In most cases, she says, it’s due to undiagnosed coronary artery disease that leads to a heart attack. With coronary artery disease, plaque builds up and narrows the arteries, and in turn, interferes with blood flow to the heart, as the Mayo Clinic explains. If a coronary artery is completely blocked, a heart attack can occur. (Elfering learned she had a complete blockage in a lower artery after her heart attack.)
It's not unusual for a heart attack to occur in this case during a strenuous event like a marathon, given that the heart has to work even harder during vigorous exercise, Dr. Haythe says. Dr. Haythe also notes that having an undiagnosed heart problem can cause an abnormal heart rhythm, which in turn can cause a sudden cardiac arrest in some cases.
While there are many factors that go into cardiac events, genetics definitely play a role, Sanjiv Patel, M.D., a cardiologist at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, Calif., tells SELF. Having a family history of heart disease increases your risk of developing it. That’s why he recommends getting evaluated by a doctor—even if you don't have any symptoms—if you have a family history of a sudden death in the family at a young age, heart disease, or of the heart being weak at a younger age.
Dr. Haythe specifically recommends asking your doctor for an electrocardiogram (EKG), an echo ultrasound of your heart, or a stress test—all of which can help detect whether there is anything off with your heart and help you take the appropriate steps to further protect yourself (like adjusting your diet and exercise habits, for instance) moving forward.
Of course, just because you have a family history of heart disease doesn't mean that you are guaranteed to have the same health issues. But educating yourself about the risk factors and symptoms to look out for is key when it comes to protecting your health.
It's also important to understand the various ways that heart attack symptoms can present, because they are not all obvious, especially in women.
As SELF reported previously, many people assume that you have to have sharp chest pain to be having a heart attack, which is not the case. Other, more vague symptoms include chest tightness or pressure; fatigue; shortness of breath; sudden sweating; or pain that radiates to other parts of the body like the arms, jaw, shoulder, or neck.
That being said, it’s not uncommon to have no warning signs before a heart attack, Dr. Patel says. “Some people may be fortunate enough to have warning signs like dizziness, but not everyone does,” he says. That’s why, “if you have a family history of heart disease, you should get checked out,” Dr. Patel says.
And if you ever feel like something doesn't feel right but you're unsure whether it's serious or not, don't delay seeking medical attention—check in with your doctor.
Elfering is now working with a medical team in Minnesota, and she’s hoping to get back to her active lifestyle again soon.
“I have restrictions on activity and movement of my arm, which is hard for me to follow since I enjoy being active,” she says. She also discovered she has post-traumatic stress disorder (PTSD) as a result of her heart events and dealing with so many unknowns about her health. “I am used to being in control of my body and life and, at this point, it feels outside of my control,” she explains. Elfering also isn’t allowed to drive, so she has to rely on family and friends to get places. “I have gone from being a very independent person to someone that is dependent on others,” she says. “Everyone is happy to help and support me, but I am not used to being in that position.”
Ultimately, she wants to encourage people with a family history of heart disease to “take it seriously and at least have an initial conversation and baseline established with a professional in the medical field. I always thought it potentially could be an issue for me, but never imagined at this age.”
She also hopes that her story inspires people to get certified in CPR. “You never know at what point in your life that you could run across someone that needs help,” she says.