Ed Frauenheim frequently walked the hilly streets around his San Francisco neighborhood. One summer day, he took long strides to his favorite park. As always, he huffed and puffed a bit up the steep ascent.
Walking back down the hill was another story.
Suddenly, he felt his chest tighten. A wave of nausea surged through him. He felt dizzy and lightheaded. Afraid he might pass out, Frauenheim eased onto the sidewalk. After a few minutes of rest, the sensations vanished. He headed home.
When he told his wife, Rowena Richie, what had happened, she figured it was something minor.
"Maybe you didn't eat enough at breakfast," she told him. "Or you need to drink more water."
He thought she could be right. He made a work call, but the episode nagged at him enough that he called the medical help line provided by his health insurer.
A nurse advised him to go to the emergency room – immediately.
A blood test showed elevated levels of troponin, an indication that he likely had a heart attack. An electrocardiogram indicated the same thing. Then the doctor entered his room and confirmed it.
"It looks like you had a mild heart attack," she said.
He stared at her, motionless.
"I know this is a lot to take in," she said. "We're going to take care of you. You're in the best place possible."
Until then, Frauenheim had tried to be stoic and brave. But an emotional dam broke, and tears streamed down his face.
The diagnosis seemed impossible. At 53, he was trim and fit. Along with eating well and walking hilly terrain, he swam and did yoga regularly.
Fear coursed through his body. Would he die, leaving his wife and two teenage children behind?
A cardiac catheterization procedure the next day showed Frauenheim had experienced a coronary artery spasm, a temporary tightening of the muscles in the wall of an artery supplying the heart. If it lasts long enough, it can cause damage; that's what happened to Frauenheim.
Doctors showed him a video of the procedure. One artery branch laid crimped in a zigzag shape. When a small tube squirted out a bit of liquid nitroglycerin, the artery sprang back open.
Doctors told him the spasms are typically caused by drugs, smoking or stress. The first two didn't apply to him, but stress certainly did.
Frauenheim has battled anxiety for years. He'd had panic attacks and even imagined physical ailments.
Also, in the beginning of 2021, six months before the heart attack, he'd left his job writing content for a workplace organization to work for himself. He'd taken on a slew of exciting projects that turned into too many hours of work.
At home, he was teaching his teens to drive in San Francisco, a task that fed into his anxieties related to safety.
Frauenheim was so worried about having another heart attack that his anxiety triggered a panic attack soon after leaving the hospital. Only after doctors thoroughly tested him did he believe it was anxiety and not his heart.
His wife recognized the vicious cycle he faced.
"Ed kept thinking, 'Oh no, don't get stressed. Oh no, don't get stressed,' which of course is stressful," Richie said.
Frauenheim has made some lifestyle changes, including exercising more and working less. He's taking medication and seeing a psychiatrist. He also believes a key to healing has been examining and challenging expectations for men to be tough, tireless providers and achievers.
Having co-written a book the previous year about how men can embrace compassion and connection for a healthier, fuller life, this amounted to taking his own advice.
With attitude and behavior changes, Frauenheim said his life is fuller and happier.
"I'm going after my dreams with less fear and relating to my friends, family and colleagues with greater honesty and depth," he said.
Both he and Richie said they wished the hospital had provided more information about the emotional effects of having a heart attack, especially since anxiety likely contributed to Frauenheim's.
Through writing and workshops, Frauenheim is now on a mission to reach out to other men who have had heart events and help them work through some of the issues caused by trying to live up to unhealthy versions of masculinity.
"Research shows heart attacks and other coronary incidents often undermine a man's sense of himself," he said. "Healing from this health scare required more from me than just taking medicine and changing my lifestyle."
Stories From the Heart chronicles the inspiring journeys of heart disease and stroke survivors, caregivers and advocates.