One evening in July 2022, Casalan Bittle, a 47-year-old single mother from suburban Northbrook, started experiencing indigestion, which she thought was due to a burger she had the night before.
Bittle tucked her kids in bed and went to sleep, but woke up a few hours later feeling nauseous. She tried to vomit but couldn’t.
“I lay on the bathroom floor and gradually felt more nauseous and then a little sweaty,” she recollected, spending around 90 minutes on the floor. Bittle attempted to get up to shower but realized she didn’t have the strength to stand.
Suddenly, she began to panic.
Bittle managed to get up, which caused discomfort in her chest and shortness of breath. Somehow, she made her way to her mother, who happened to be visiting. Then, out of nowhere, the single mother of two lost consciousness for five minutes.
Paramedics arrived and rushed Bittle to a local hospital, where doctors revealed shocking news – she was having a heart attack.
“The last thing I remember — I don’t recommend it — was being defibrillated,” she recalled in an interview with TODAY.com. “I remember being electrocuted alive.”
Bittle, though not yet 50 years old, had no known health conditions and was regular with her exercise regime. She had even conquered Mount Kilamanjaro and just months earlier underwent an annual physical, which included an EKG. Doctors treating her found that she had a 100% blockage in the main artery of the heart, often referred to as a widow-maker heart attack.
The single mother of two was fighting for her life.
The last thing I remember — I don’t recommend it — was being defibrillated. I remember being electrocuted alive. Casalan Bittle, a mother of two from Northbrook
Doctors inserted a stent, intubated her, and placed her on extracorporeal membrane oxygenation, also known as ECMO, which is “the most intense form of life support that somebody can receive,” according to Dr. Bow (Ben) Chung, a cardiologist with the University of Chicago Medicine who treated Bittle.
“This was basically about as sick as a person can be, from a heart perspective,” he said.
Bittle’s family was advised to bid her farewell, being told that a heart transplant appeared to be the only solution. After experiencing multiple cardiac arrests in the hospital, doctors were worried about the extent of Bittle’s brain function.
She was put on an urgent transplant list and transferred to the University of Chicago Medical Center in the hope that a heart would become available.
“Very miraculously, after what I understand to be a lot of craziness, my heart recovered to an extent where (they) thought, ‘OK, maybe we don’t need a transplant right now. Let’s wake her up,'” Bittle said.
Within a few days, she was taken off ECMO and had the heart pump removed, but faced another challenge: Bittle developed blood clots in both her right and left femoral arteries, leading to a loss of circulation in her leg. She underwent emergency surgery, where surgeons saved her leg and fixed the arteries.
From there, things became a little calmer as she concentrated on recuperation.
Bittle spent near two weeks in the hospital, followed by six weeks of outpatient rehabilitation and a further 18 weeks of cardiac rehabilitation. She also wore a LifeVest, a wearable defibrillator, for 90 days.
In February 2023, she had a tough day during outpatient rehab.
“It was just a tickle in my chest,” she said. “And I went to cardiac rehab and I was walking on the treadmill, and it felt more difficult than it did the day before.”
As a precaution, her doctor sent her for a stress test. The results were “not highly concerning, but just a little odd,” Bittle explained. So, once more, out of caution, her doctor ordered further testing, which revealed she had a 70% blockage in the main artery.
If left undetected, it could have caused another heart attack.
It’s not uncommon for people to experience a second heart attack after surviving their first, Chung said, but it was unusual for another blockage to develop under these circumstances.
Sarah Casalon Bittle is pictured at the summit of Mount Kilamanjaro. Bittle climbed the mountain prior to July 2022, when she had a “widow-maker” heart attack.
“At that point, she was on all of the right medications … to prevent another heart attack,” he explained.
Instead of undergoing open-heart surgery, doctors offered Bittle the option of robotic cardiac surgery, where the heart doesn’t need to be stopped. Additionally, patients can return home within a day or two and resume their normal activities.
Almost a year after her robotic surgery, Bittle is doing “fantastic,” she said. “Most days, I would never know.”
She still has some remaining heart damage, takes medication daily and experiences days where she gets winded and needs to take it easy.
“I will be a heart failure patient for the rest of my life, but my recovery is nothing short of remarkable,” she said.
One of the biggest reminders of her health journey is the scars she has, but even those have become a source of connection.
At times she compares scars with her son, who had heart surgery at 10 months for a congenital condition.
“We’re both heart warriors,” she stated.
In a previous interview with the University of Chicago Medicine, Bittle acknowledged she “survived the unsurvivable.”
“…I survived the unsurvivable, right?” she stated. “I have access to extraordinary medical and rehabilitative care. That’s a privilege, and I’m so incredibly lucky. And now I’m going to go live a long life.”
Reflecting on her experience, Bittle wishes she had been aware of how common heart attacks are in women and that women may have subtler symptoms compared to men. The most common symptom, regardless of gender, is chest pain.
According to Chung, many people are hesitant to label something as pain. It can manifest as discomfort, pressure, tightness or a persistent feeling.
“Many women think it has to be, ‘I’m clutching my chest and falling down on the ground like you see in the movies,’ and it can be much more subtle,” Dr. Tara Narula, NBC medical contributor, explained on a Feb. 1, 2024, TODAY show segment.
Other subtle signals that may indicate a heart attack include unusual indigestion and sudden nausea, similar to Bittle’s experience, as well as shortness of breath and shooting pain in the jaw, back, arm or shoulder. Women are more likely to experience these easily-missed symptoms than men, Chung explained.
Heart attack symptoms in women can include:
Chest pain, discomfort, heaviness, tightness or pressure
Jaw, neck, shoulder or upper back pain
Nausea, vomiting or indigestion
Shortness of breath
Extreme fatigue or fainting
Research shows that women are also significantly more likely than men to die after a heart attack, probably due to delays in diagnosis and treatment.
The key takeaway is that if you’re experiencing a symptom that’s unusual for you, especially if it persists, you should seek medical attention, Chung stressed.
“You don’t have to go to the emergency department, but talking to your primary care doctor or going to an urgent care would probably be the best just to have an evaluation,” he said.
As Bittle puts it, “Don’t think you’re being silly. Get help right away.”
Considering all she has survived, Bittle said she feels a sense of “gratitude and amazement,” and refuses to let negativity bring her down.
“It’s not worth me spending my energy in a negative place,” she said, “because I’ve spent all my energy on staying alive.”
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