The fellow vocalist called 911 and helped Marciel remove her head piece and change out of her swimsuit and into street clothes. “While we were waiting for the ambulance, I laid on the floor with all these folks who were part of the production and the lead singer surrounding me, holding my hand and telling me everything was going to be okay,” she says. “It was a surreal experience.” In the hospital emergency room, the doctor told her that she was having a heart attack. But Marciel wasn’t buying it. “I remember thinking: ‘No, the pain is exactly the same as last time. It’s myocarditis again,’” she says. In the procedure room, Marciel called her family and told them she was in the hospital with what she thought was myocarditis. That’s all that she remembers from that day. The following morning she awoke in a recovery room at the hospital and a doctor confirmed she had had a heart attack. “I still had my show eyelashes on,” she says. Overnight, Marciel had undergone an angioplasty and stenting to unblock a clogged artery. “The doctor showed me where the blockages happened and what he had done,” she says. “He also told me I was anemic,” which can be a contributing factor when you’re already at risk for heart disease. In fact, a study published in October 2021 in ESC Heart Failure found that iron deficiency can increase the risk of developing heart disease and dying from the condition. Doctors said that the myocarditis and the heart attack were not related because they affected two separate areas of Marciel’s heart. But, in fact, Marciel later learned that inflammation from myocarditis can affect the blood vessels of the heart, which may have contributed to her heart attack. At the time, though, the situation was confusing. “I just didn’t understand how at 39, I had had a heart attack,” Marciel says. “I knew heart attack was the leading cause of death in women, but I pictured that as older women and I thought I was healthy.”
Know the Signs of Heart Attack in Women
It’s true that heart attacks occur most often in older people. The average age of a first heart attack is 65 for men and 72 for women, according to the American Heart Association (AHA). But research, including one study published in November 2019 in Circulation, signals that heart attacks are becoming more common in adults 35 to 54, especially in women. Crushing chest pain is a telltale sign of a heart attack, and more typical in men than women. But that’s not what Marciel experienced. “Having a heart attack was nothing like I imagined it would feel like,” she says. “The pain felt much more intense in my back.” Men and women can experience heart attack symptoms differently. “Most women and men having a heart attack present with some sensation in their chest,” says Annabelle Volgman, MD, medical director of the Rush Heart Center for Women in Chicago. “But women are more likely to describe it as chest pressure.” Women are also more likely to experience symptoms such as nausea, fatigue, and shortness of breath, according to updated chest pain management guidelines published in November 2021 in the Journal of the American College of Cardiology. Marciel’s doctors took her heart attack symptoms seriously. She was lucky. “Young women with no risk factors who look healthy are apt to be dismissed in the emergency department,” Dr. Volgman says. If you experience symptoms of heart attack, particularly shortness of breath, nausea or vomiting, and back or jaw pain with or without chest pain, call 911 and insist on being evaluated for heart attack, especially if you have risk factors, such as:
Being a smokerHigh cholesterolDiabetesA family history of premature heart disease
Volgman says that she counsels her patients who are at risk for heart attack to ask for an electrocardiogram (EKG) and high-sensitivity cardiac troponin in the emergency room, a blood test to diagnose a heart attack. “To get the best cardiac care, it’s important to be proactive,” Volgman says.
Marciel Focused on Her Diet to Improve Heart Health
Marciel was prescribed cholesterol-lowering statin medication, and for a time, blood pressure medication and iron supplements to boost her iron levels. According to the AHA–American College of Cardiology guidelines, published in November 2018 in Circulation, an optimal LDL (“bad”) cholesterol level is less than 100 milligrams per deciliter (mg/dL). Before her heart attack, Marciel’s cholesterol had been on the high side, but her physician wasn’t concerned, likely because of her age. While recovering from her heart attack at home, Marciel began to take stock of her lifestyle. “I said to myself, ‘What am I not doing right?” she says. Marciel had always been physically active, but after her heart attack, she realized her eating habits could use improvement. “As an entertainer with the late nights, you compromise on diet because of what’s available,” Marciel says. Midnight runs to Jack in the Box were a regular thing. “I thought, ‘I have this great metabolism. I’m not gaining weight. Things are fine. But that’s not the case. Your size doesn’t determine whether you have great cholesterol numbers,” she says. Marciel began to plan ahead and pack fruits and raw vegetables so she would always have healthy options on hand. She cut down on red meat as well. “I grew up in Hawaii and we always had a lot of fish in our diet. So that was an easy thing to lean more towards,” she says. The AHA recommends eating two servings of fish per week, particularly fatty fish, such as salmon, bluefin tuna, striped bass, or black cod. Fish is a good source of lean protein and omega-3 fatty acids, which reduces the risk of heart disease. As part of a heart-healthy eating pattern, the AHA 2021 Dietary Guidance to Improve Cardiovascular Health, published in November 2021 in Circulation, also recommends eating plenty of fruits and vegetables, choosing whole grains (think oatmeal and whole-grain bread), and using liquid plant oils, such as olive oil, rather than tropical oils, animal fats, and partially hydrogenated (trans) fats. The guidelines also emphasize choosing foods that are minimally processed, keeping sugary foods and beverages to a minimum, and preparing food with little or no salt. “A good strategy for a heart-healthy eating pattern is to have the components in your house so you have something to work with, such as frozen produce for soups and stews, frozen berries, and fish and chicken,” says Alice Lichtenstein, DSc, senior scientist and director of the cardiovascular nutrition team at the Jean Mayer USDA Human Nutrition Research Cancer on Aging in Boston. In other words, when you have healthy options on hand, you’re less likely to resort to fast food. But keep in mind that a heart-healthy eating pattern is flexible. “If you have a favorite fast food once in a while, it’s not the end of the world,” Dr. Lichtenstein says.
A Death in the Family Is a Wake-Up Call for Tricia Marciel
As Marciel was getting her eating habits on a healthier track, she experienced another blow: Her mom, who had always had a host of health issues, including one that necessitated open-heart surgery in her fifties, passed away from kidney failure, a complication from type 2 diabetes. “My mom’s passing was another wake-up call. That’s when I really shifted gears,” she says. “I said to myself, ‘You’ve got to do what makes you happy.” Until then, she had been working two jobs: in the communications department at a hospital from 9 to 5 and performing in local variety shows in the evening. She was overworked and stressed and not really doing what she loved. “My whole life, I’ve been mesmerized by the performing arts,” Marciel says. “It has been part of my life since I was a child.” A chance audition landed her a full-time job as a performer on a cruise ship, singing and dancing in two shows per night, six to seven months out of the year, while sailing around the globe. That was three years ago. Fortunately, Marciel’s cruise ship offers plenty of healthy dietary options, such as salads and grilled chicken, to accommodate diet-conscious passengers and staff. When the ship is in port, Marciel shops for healthy snacks and seeks out healthy restaurant options. “We live in a time when you can Google whatever city you’re going to be in and research the healthy places to eat,” she says. Now 49, Marciel says, “I’m doing what makes me happy and I feel healthy and inspired.” As one of the 2022 American Heart Association’s Class of Real Women, Marciel says that she is on a mission. “I want to help other women take better care of themselves,” she says. “If my story can help one woman make changes to her diet or her lifestyle to prevent something that might happen in a couple of years, that means the world to me.”
