She Was Told Her Heart Was 'Fine.' Eighteen Months Later, She Had a Stent.
Boundless Journal — Joint & Heart Health
https://boundlesssociety.com/blog/heart-fine-then-stent
Published: 2026-06-16

A third-person account based on documented clinical presentations. Margaret's ECG was normal, her blood pressure was managed, her doctor was not concerned. What her tests did not catch is a story that plays out more often than most people know.

KEY STATISTICS
- 50% of women over 65 with coronary artery disease have a normal resting ECG
  (Resting ECG has 45-68% sensitivity for CAD — it misses roughly half of significant cases)
- 1 in 3 women who have a heart attack report their symptoms were previously dismissed
  (British Heart Foundation, 2023)

THE EIGHTEEN-MONTH TIMELINE
Month 1: First fatigue report. Blood panel shows low ferritin. Prescribed iron supplements.
Month 4: Fatigue persists. Attributed to post-menopausal change and work stress. No cardiac investigation.
Month 7: Exertional upper back ache — first episode. Attributed to posture or costochondritis.
Month 10: Two further exertional episodes, increasingly reliable. GP notes suggest musculoskeletal origin.
Month 14: New GP takes full history. Recognises pattern: exertional symptoms relieving at rest. Urgent cardiology referral.
Month 15: Stress echocardiogram reveals significant wall motion abnormality under stress. Angiography arranged.
Month 16: Angiography shows 80% stenosis in left anterior descending artery. Stent placed.
Month 18: Cardiac rehabilitation completed. Full return to activity.

WHAT THE TESTS DID NOT CATCH — AND WHY
A resting ECG measures electrical activity at rest. It is excellent at identifying arrhythmias and acute infarction. It is significantly less useful for detecting coronary artery disease — gradual narrowing of arteries that does not show its impact until the heart is working hard enough to need more blood than the narrowed vessel can supply.

Exertional symptoms — symptoms appearing during activity and resolving with rest — are the cardinal warning sign of coronary artery disease. In women over 60, angina frequently does not present as chest pain, and is frequently not recognised as cardiac by either patient or clinician.

THE TEST THAT CHANGED EVERYTHING
A stress echocardiogram is an ultrasound performed during or immediately after physical stress. It reveals how pumping function changes under demand. Regions supplied by narrowed arteries show abnormal wall motion under stress. This is what identified Margaret's stenosis.

The new GP who saw Margaret asked specifically about the relationship between symptoms and exertion. Margaret described the back ache appearing on walks and resolving at rest. The GP referred within the week. That question — asked for the first time in fourteen months — was the turning point.

WHAT MARGARET DOES DIFFERENTLY NOW
She mentions exertional symptoms first and explicitly — as the lead, not an aside. She tracks resting heart rate each morning. She attends annual cardiology review and asks directly about imaging schedule. She says she wishes she had known earlier: a normal ECG and managed blood pressure do not mean the coronary arteries are unobstructed. Those are different questions requiring different tests.

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