Chest Pain Patient Case Study
Mrs L.U. aged 49: In retrospect, Mrs L.U. had many of the features of Hughes Syndrome/APS, going back over at least 25 years.
In her early 20s she was investigated for infertility. She felt that on at least a couple of occasions, she had in fact become pregnant but miscarried early.
Throughout her 20s she suffered frequent migraine attacks, with only partial relief from migraine tablets. In her 30s she developed problems with balance and was returned to a 'balance' department of a teaching hospital.
In her 30s and early 40s, the headaches and balance problems continued. By now she was suffering worrying memory loss - difficulty in finding words, for example. She had also started to suffer dull chest pains - slightly cramping, sometimes brought on by stress.
She wondered if this was angina, but she had so many other medical problems - and she was a non-smoker, and her blood pressure had been checked and was normal
It was a Neurologist (nerve doctor) who put the full picture together. Mrs L.U. was by now suffering from frequent "TIA’s" (mini strokes). He arranged for blood tests and referred her to
Professor Hughes.
The blood tests were all positive for antiphospholipid antibodies, and the brain scan arranged by the neurologist showed a number of small lesions consistent with mini clots.
Her response to anticoagulation (Warfarin, with an INR of 3.8 to 4) has been nothing short of a miracle. Balance better, headaches gone, memory dramatically improved. And the chest pain disappeared.
What is this patient teaching us?
Apart from the more well-known features of Hughes syndrome, heart angina is seen in some cases.
Although we described angina, and even heart attacks in some of our patients back in the early 1980s, a connection with antiphospholipid antibodies (aPL) has taken some time to be widely recognised.
However, during the past few years, big studies are coming out of cardiology departments, recognising that Hughes Syndrome may in fact be an important cause of cardiac ischemia (lack of blood supply), especially in women. Hughes Syndrome causes several other cardiac manifestations including thickening or “vegetations” on the heart valves, and blood clots in the heart itself as well as high pressure in the lungs (pulmonary Hypertension) which causes strain on the right heart.
In some cases, investigation of the angina has, surprisingly, turned up normal looking coronary arteries a condition the cardiologists call 'Syndrome X'. Interestingly in our own clinical studies, we have reported a significant number of cases of 'Syndrome X' in our clinic.
Whatever the cause, it makes sense to recognise that 'sticky blood' can affect the heart just as it can the other organs of the body.
Another reason to request the simple blood tests for Hughes Syndrome.
Many of the details of Mrs L.U.'s case resemble those of another patient, Mrs Kay Thackray, whose book "Sticky Blood Explained - 2002" is one of the best descriptions of Hughes Syndrome I have read.