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Clinical Research Essential to Understanding Heart Disease, Advocate Says

By Shelly Reese

In 2004, five days after giving birth to her third child, 36-year-old Rhonda Monroe nursed her newborn daughter, laid her in her cradle, and suffered a massive heart attack.

“I felt like an elephant was sitting on my chest,” says Rhonda, who was living in Charlotte, NC at the time. “I vomited and called 911.”

Despite Rhonda’s classic symptoms and a confirming EKG by the paramedics, doctors did not diagnose her condition for nearly a week.

“I kept telling them. ‘I’m having a heart attack,’ but I wasn’t an overweight middle-aged white guy, so they kept saying, ‘You can’t be having a heart attack.’”

A second EKG ultimately showed Rhonda was indeed experiencing a heart attack and further examination showed why: five of her coronary arteries had dissected. Blood was leaking through tears in the layers of her artery walls and the trapped blood was causing the artery walls to bulge inward, constricting the flow of blood to the heart.

Rhonda underwent a quadruple bypass and later had a defibrillator implanted, but she continued to suffer from chest pain and poor circulation. In February 2005 she went to see a heart specialist in Washington, DC only to discover she had congestive heart failure and her arteries were once again blocked.

“They said, ‘There is nothing we can do and nobody is going to operate on you because you are too high a risk,” she recalls. Rhonda laid in MedStar Washington Hospital Center for several weeks trying to convince doctors she should be a surgical candidate. In the midst of her lobbying efforts, Dr. Lowell Satler approached Rhonda with the opportunity to participate in a clinical trial exploring whether a Cypher drug-eluting stent could benefit patients who had already undergone bypass surgery.

Having suffered adverse reactions to heparin and some other heart medications, Rhonda had concerns about the use of a drug-coated material but was none the less eager to participate in the trial.

During her months-long recovery from bypass surgery she had learned a lot about heart disease and clinical research.

“I did as much research as I could so I could be a well-informed partner in my healthcare, and what I learned is that women aren’t invited to participate in clinical trials as often as men. That helps explain why when I went to the hospital in 2004 they didn’t take me seriously. I had a classic Hollywood heart attack, but nobody paid any attention because I wasn’t a middle aged white guy. So when I had a chance to participate in a trial, my attitude was, ‘Pick me! Pick me!’ I participated because I didn’t want anybody else to be turned away the way I had been.”

The trial involved undergoing a balloon angioplasty in which two stents coated with anti-rejection medication were inserted into Rhonda’s heart to provide a scaffolding that would hold the arteries open. Afterward she would take Plavix for a year and undergo monitoring. Unfortunately, the surgery did not improve Rhonda’s ejection fraction — a measure of the heart’s pumping efficiency – or ease her pain.

Fortunately for Rhonda, although the stents failed, her persistence won over Dr. Steven Boyce, who ultimately agreed to perform a complicated surgery that involved a repeat bypass procedure, surgical ventricular reduction to remove a damaged section of her heart, and transmyocardial revascularization, which involved drilling 15 holes in her heart with a laser to promote additional blood flow.

The surgery worked. Today Rhonda, who now lives in Bethesda, Md., is an advocate for women’s heart health and patient education.

Looking back on her experience with clinical research, Rhonda has no regrets about participating in a trial and advises others to consider doing the same. “Do your research and, if you think it will work for you, get involved. Even if it doesn’t benefit you personally, the information helps others.”

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