What is a ‘Widowmaker’ Heart Attack?

Every 40 seconds, someone in the United States has a heart attack, according to the American Heart Association.

While any heart attack can be dangerous, the­­­ threat of a widowmaker heart attack recently gained attention after “Everybody Loves Raymond” actor Ray Romano shared that he underwent a procedure clearing a blockage in one of his main arteries to avoid the cardiac event.

The term “widowmaker” historically comes from the greater risk of a 100% blockage in the left anterior descending (LAD) artery, which carries almost 50% of the blood to your heart muscle, says Dr. Ajay J. Kirtane, interventional cardiologist and director of cardiac catheterization laboratories at NewYork-Presbyterian/Columbia University Irving Medical Center.

“While it’s important to take that kind of blockage very seriously, I don’t typically like to use that term as it’s too gender-specific,” he says. “One of the most important things to remember is that heart disease can equally affect both men and women.”

Dr. Kirtane, who is also a professor of medicine at Columbia University Vagelos College of Physicians and Surgeons, spoke with Health Matters to explain what you need to know about the so-called widowmaker heart attack, including causes, symptoms, and prevention.

What are the widowmaker artery and a widowmaker heart attack?
Dr. Kirtane: There are three major arteries of the heart that supply blood to the heart muscle. While blockages can occur in other artery branches, a complete blockage in any of those three major arteries can cause a major heart attack.

The LAD artery supplies the most amount of blood to the heart, which is often why it gets the most recognition. What people call a widowmaker heart attack is caused by a 100% blockage of plaque, or cholesterol buildup, upstream in the LAD artery.

What happens during a heart attack?
During a heart attack, blood flow that brings oxygen to the heart is reduced or cut off.

If you think of your heart as a house with pipes, a heart attack can be caused by a process that cakes the walls across all the pipes. Usually, this is caused by a buildup of cholesterol plaque. The plaque becomes less stable over time and tends to clot off at a certain location.

If an artery becomes fully clotted, there’s no more blood flow and it can cause heart tissue to die.

There may be one area that has a very severe blockage that needs to be opened. You can also have blockages in multiple vessels.

Who is at risk?
Those at risk for a heart attack include people with:

• Family history of heart attack or heart disease
• Diabetes
• High blood pressure and cholesterol

What are symptoms of a heart attack?
Symptoms include:

• Chest pain or discomfort
• Excessive fatigue
• Shortness of breath
• Indigestion

Patients who are older, women, or those who have diabetes may not experience typical chest pain and symptoms could be more subtle. If you develop any symptoms for the first time, it suggests that something is changing with your arteries, and you need to seek immediate medical attention.

Call 911. Cardiologists often say, “Time is muscle.” The longer you wait, the more muscle dies.

What’s the treatment?
If the LAD artery has significant blockage but isn’t completely clogged, you may be able to catch it in time to prevent a heart attack. If you’re diagnosed with significant heart artery blockages or a heart attack, the blockage is opened to restore blood flow.

Your physician and care team will first do a cardiac catheterization procedure, where we go into the artery in the wrist where you feel your pulse. We take pictures to make the diagnosis, then based on the diagnosis we may decide to perform an angioplasty procedure to open the blockage and a stent to keep the artery open.

In other cases, we might suggest coronary artery bypass surgery or taking a more aggressive treatment with medication alone. It depends on the types of blockages, where they’re located, how severe they are, and what the best options are for the individual patient.

What’s life like after a heart attack?
We ultimately want patients not only at their full level of functioning but sometimes doing even more than they were doing before, as they transition to a healthier lifestyle.

A lot of people get motivated to change what they’re doing in their life after a heart attack or severe blockage. Those are some of the most empowering stories from my patients who’ve taken it quite literally to heart and have changed their lifestyles for the better. Patients usually will start with cardiac rehabilitation, which is supervised exercise training.

Going back to your heart being a house, the idea is to prevent plaque buildup everywhere to minimize the risk of occurrence in any one place. It’s important to maintain a healthy lifestyle, but if you have high cholesterol, take the recommended cholesterol-lowering medications because they’re part of the maintenance that helps keep that plaque to a minimum. It’s also important to remember that there’s a high incidence of depression that happens after a heart attack, and relatives feel a lot of fear, so we not only treat the patient clinically but also provide emotional support for them and their family.

How can you prevent a heart attack?
Preventative care is essential. The time to effect change in your heart arteries is usually going to be decades before the heart artery disease manifests. If we don’t live healthy lifestyles in our 20s, 30s, and 40s, then we start having problems in our 50s, 60s, and 70s.

Ways to improve heart health include:

• Healthy, sustainable diet
• Exercise, including 35 to 40 minutes of aerobic exercise four to five times a week
• Lowering cholesterol

When your cholesterol goes down, it’s not only the number — inside the heart arteries, the plaque either stops growing or gets smaller.

On top of that plaque there’s something we call a fibrous cap, which is like a tarpaulin that covers the buildup. If you’re on cholesterol-lowering medication, the cap thickens, which decreases the likelihood that plaque can break through and cause blockages.

As a physician, I often will set a plan with my patients. Heart attack patients need aggressive control of cholesterol. For patients without heart attacks, if cholesterol is elevated, I support motivated patients’ efforts to lower it with lifestyle and diet changes, because that can really work. But if it doesn’t change in a fixed period of time, we work to come up with a plan for additional interventions, so we don’t get into a cycle where riskier cardiac events can start occurring.