A woman dismissed her exhaustion as anxiety, asthma, and menopause. She actually needed a heart transplant and brain surgery.

• Ann Ramirez Dudas was a self-described "go-getter" before she was diagnosed with heart failure.
• She needed a new heart when she was 50 years old, as she struggled to breathe and keep food down.

When Ann Ramirez Duda woke up in the middle of the night struggling to breathe, she thought she must be having a panic attack.

It was the summer of 2018, and Duda, then 48, was taking care of her ailing father at home. She told Insider she assumed her shortness of breath was caused by anxiety and exacerbated by the wildfires that were raging in California at the time.

"It was the fires, the menopause; it's the kids, or too much work," she said. "Never in my million years did I ever think it was my heart."

After postponing two doctor's appointments, Duda finally saw her primary care doctor in October 2018. She was diagnosed with congestive heart failure, which was causing her to feel breathless and exhausted. Medication and a new diet would help her manage the condition, but eventually, she would need a new heart.

Duda said she has learned to advocate for her health throughout her lengthy medical journey. Now, she's sharing her story as a volunteer for the American Heart Association's Go Red For Women "Real Women" campaign.

Backed-up fluid in the lungs was making her feel short of breath

Congestive heart failure occurs when the heart muscle doesn't pump as well as it should, leading to a buildup of blood in the veins. Compared to other types of heart failure, CHF must be treated quickly to prevent fluid from collecting in the lungs.

At the time of her diagnosis, Dudas was already having trouble breathing. She said she could not walk from her car to the gym where she taught children's gymnastics without stopping to catch her breath.

"It was at that point that the doctor even dropped the word transplant, but as a far away thing," Dudas said.

For two years, Dudas managed her condition with medication, a low-sodium diet, and closely monitoring her fluid intake. Too much fluid could send her into respiratory distress or cause swelling, as her heart failure also affected her kidneys' ability to clear salt and water from the body, according to the American Heart Association.

Her health took a 'nosedive' in 2020

In March 2020, Dudas said her health took a scary turn.

"I started losing weight. I couldn't hold any food down," she said. "I would just wake up during the night and be throwing up — and it wasn't even like I was eating anything."

Doctors told Dudas that she had developed mitral valve regurgitation, which was causing blood to flow backward in the heart. Her ejection fraction — a measure of how the heart contracts and relaxes — plummeted from bad to worse.

She was hospitalized in April 2020, then again in September at her local hospital. She said she advocated to get herself admitted at UCLA instead of going back and forth.

Dudas said she remembers telling her doctor, "With all due respect, I know you have your team to consult with, but I have mine. My team consists of my three daughters and my grandson, and we don't have time."

She was admitted to UCLA Health on October 6, 2020, and she wouldn't leave the hospital until she had a new heart.

In prep for her transplant, doctors found a brain tumor that needed to be removed

During one evaluation for her heart transplant, Dudas said she asked her doctor to come to the other side of her bed. She was having trouble seeing out of her right eye, and the doctor was outside of her field of vision.

A CAT scan revealed a tumor the size of a golf ball was pressing on her optic nerve. Dudas was pulled from the transplant list as soon as she got on it, as her doctors opted to remove the tumor before her heart surgery.

"The discussion became, do we take out the brain tumor first and then do a heart transplant, or do we do a heart transplant first and then do a brain surgery?" she said. "They weren't sure if I would survive the brain surgery without the heart."

Doctors inserted a balloon pump in her groin to help blood move throughout the body until she got a new heart. Then, they took her to surgery and removed the tumor through her nose.

"In hindsight, the brain tumor surgery was harder than the heart transplant," she said.

She got a new heart two weeks later

Dudas said she was cleared to get back on the transplant list 10 days post-surgery, on October 31. She had a successful heart transplant on November 7, 2020.

The medical team had Dudas up and walking the day after surgery, and she said it was "glorious."

"My daughter looked at me and started crying and said, 'Oh my god, Mommy's got color in her face.' They were so used to seeing me look gray and ashen," she said.

Dudas, now 53, said she is still legally blind in her right eye after the brain surgery. As for her heart, she's determined to make it count.

"I still watch what I eat. I have to exercise even when I'm tired," she said. "I have to treat it right, because otherwise the gift was wasted. And I'm here just to prove that it wasn't wasted."