Widowmaker heart attack is essentially a high mortality risk attack triggered as a result of 100 percent blockage that occurs in the heart’s most important artery known as Left Anterior Descending Artery (LAD). Interestingly, both men and women are equally at risk of the widowmaker heart attack.
“There is a high risk of death associated with this type of heart attack. Hence, it is known as widowmaker,” explains Dr Sanjay Chugh, Senior Consultant and Associate Director of Cardiology and Interventional Cardiology at Narayana Healthcare Super speciality Hospital, Gurugram.
He explains that LAD is the most important and the largest heart artery which provides blood to an important and major part of the heart’s left ventricle. This ventricle is the heart’s lower left chamber and has a crucial role of pumping oxygenated blood through the aorta to be distributed throughout the body.
“When the atherosclerotic plaque in the widowmaker coronary artery (LAD) causes a stenosis (narrowing) it ruptures, leading to superimposed blood clot formation, then a total block in the artery ensues and causes a heart attack,” explains Dr Chugh.
Dr Keshav R, Director-Interventional Cardiology, Fortis Hospital, Cunningham Road, Bengaluru explains LAD is important as it supplies about 50 percent of oxygenated blood to the heart muscles.
LAD supplies blood to the anterior septum which extends from the base of the heart to the apex or tip and divides the left from the right ventricle.
When a big portion of the heart is deprived of the oxygenated blood flow due to blockage it causes massive myocardial infarction or death of heart muscle tissue resulting in pumping dysfunction leading to mortality or death explains Dr Chugh.
Cardiac muscle death
A widowmaker heart attack may induce cardiac arrest within 10 to 20 minutes of no blood circulation in some cases. If blood flow is not restored quickly, the heart muscle starts to die irreversibly.
“The heart function measured as ejection fraction (the amount of blood the left ventricle pumps out with each contraction) drops to 30 or 35 percent which is almost a loss of half the muscle,” explains Dr Chugh. A normal heart’s ejection fraction is somewhere between 55 to 60 per cent.
He explains that whenever the heart muscle is damaged there can be irritability in myocardium leading to arrythmia (heart rhythm disorder) that can also lead to cardiac arrest.
Widowmaker affects both genders
Dr Keshav explains that this heart attack can occur in men as well as women. Women may also experience symptoms like fatigue, nausea and sweating, among other symptoms which if not attended to timely can cause heart attack. Sometimes women don’t experience the same symptoms as men, especially chest pain.
According to an article published in the British Heart Foundation, although symptoms can vary from person to person, women and men generally experience the same heart attack symptoms. However, research shows women tend to not recognise the symptoms as a sign of a heart attack as quickly. This is mainly because heart attacks are wrongly believed to be a “man’s problem.”
In the UK, an average of four women die of coronary heart disease every hour, many of them due to a heart attack.
Widowmaker heart attack symptoms
Doctors explain the symptoms of widowmaker heart attack are no different from the other kind of heart attacks. These include:
- Chest pain
- Pain or discomfort in middle of the chest to jaw, arms or back
- Sweating
- Restlessness
- Nausea
“The severity of pain is not related to the severity of heart attack because the pain perception varies in people,” explains Dr Chugh.
Sometimes, an increase of symptoms of either heaviness in the chest or shortness of breath or some palpitations when walking may be signs of an impending heart attack which needs immediate attention.
Treatment
Dr Keshav explains that this kind of blockage requires immediate angiogram and angioplasty (angiogram is a test to check blockage in coronaries; angioplasty is a form of surgery where a balloon is used to dilate the blockage in the coronary and a metal spring called stent is implanted to keep the artery open).
“Earlier the detection the better. More the delay, more is the heart muscle damage,” says Dr Chugh.
He also explains there is irrefutable evidence that an angioplasty done through hand (transradial) saves more lives and reduces the risk of dying by half compared to an angioplasty done through the groin (transfemoral).
“When someone presents with typical symptoms of heart attack, sometimes a clinical decision is taken to do an angiogram straight away rather than wait for heart attack to show up on reports as it can be dangerous to delay,” explains Dr Chugh.
If the person is in a situation where angioplasty can’t be done then thrombolytic (busting a blood clot with a drug) is given to them.
“Low blood pressure or fluid in the lungs are common complications which can be managed with medicines and supportive care,” says Dr Chugh.
Takeaways
Widowmaker heart attack is the common name given to a heart attack in the Left Anterior Descending (LAD) artery, the biggest coronary artery. The name widowmaker has no scientific bearing and has also not aged well, as experts opine that both men and women are at risk of LAD heart attack. Like most cardiovascular complications, early diagnosis and treatment play a major role in ensuring that the LAD artery isn’t completely blocked triggering a fatal heart attack.
