Why a ‘Widowmaker’ Heart Attack Is So Dangerous

“If there’s no blood flow to the heart, the heart muscles become deprived of oxygen and vital nutrients and heart muscle damage starts immediately,” says cardiologist Penelope Rampersad, MD, MSc, FRCPC.

What Is a ‘Widowmaker’ Heart Attack?

A widowmaker heart attack is a type of heart attack that’s caused by a 100 percent blockage of the left anterior descending (LAD) artery. It’s also sometimes referred to as a chronic total obstruction (CTO).

The LAD artery carries fresh blood into the heart so that the heart gets the oxygen it needs to pump properly. If it’s blocked, the heart can stop very fast — which is why this type of heart attack is called a “widowmaker.”

But the widowmaker isn’t always fatal. Let’s take a closer look at how to know when one might be coming, what can cause it, and what treatment and recovery are like after you’ve had one.

The symptoms of a widowmaker are essentially the same as those of any type of heart attack. And as with other heart attacks, you may not notice any symptoms until the heart attack begins (and sometimes not even then).

Seek emergency medical attention immediately if you have any heart attack symptoms. Some of the warning signs and symptoms of a 100 percent LAD blockage include:

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• feeling chest pain or discomfort
• experiencing pain that radiates out into your arms, legs, back, neck, or jaw
• having pain in your abdominal area that feels like heartburn
• having muscle pain in your chest or neck that feels like a pulled muscle
• having difficulty breathing
• feeling anxious or panicky for no apparent reason
• feeling dizzy, lightheaded, or disoriented
• getting sweaty without warning
• feeling sick
• throwing up
• feeling like your heart is skipping beats

Women are more likely to experience many of these symptoms without having chest pain.

A widowmaker heart attack is caused by a complete block of the left anterior descending (LAD) artery. The LAD transports a large amount of blood into your heart, so without blood passing through the LAD, your heart can quickly run out of oxygen and stop beating.

The LAD most commonly gets blocked up with plaque from cholesterol. This condition is known as atherosclerosis, often called the “hardening of the arteries.”

Plaque can cause blood clots that obstruct the artery. In some cases, the clots can build up quickly and instantly cause a 100 percent blockage even if your LAD was only partially blocked.

The risk factors for a widowmaker heart attack, as with any heart attack, are primarily lifestyle choices or genetic factors that affect your cholesterol levels. If heart attacks run in your family, you’re more likely to have one. Also, your risk of having a heart attack increases as you get older.

Some of the lifestyle risk factors for a widowmaker heart attack include:

• smoking cigarettes or chewing tobacco regularly
• being overweight or obese
• having a diet that’s not healthy for your heart, which includes high amounts of processed grains, unhealthy fats, full-fat dairy, and sodium
• having high blood pressure
• having high amounts of low-density lipoprotein (LDL or “bad” cholesterol) in your blood
• having low amounts of high-density lipoprotein (HDL or “good” cholesterol) in your blood
• having diabetes or prediabetes
• not getting enough exercise

Genetic factors that can make you more vulnerable to a heart attack or other heart conditions include:

• Race. You’re more likely to have a heart attack if you’re of European, African-American, or Native American descent.
• Genetic conditions. Certain (often rare) conditions are passed through a single gene (called monogenic conditions) that can increase your risk for a heart attack. These can include hypertrophic cardiomyopathy a hypercholesterolemia. In some cases, conditions caused by multiple gene variants (called polygenic conditions) make you more vulnerable , such as dyslipidemia.

Head straight to the emergency room if you’re having symptoms of a heart attack. The more quickly a widowmaker is addressed and treated, the higher your chance of recovery.

The most common emergency treatment for a 100 percent LAD blockage consists of the following steps:

1. Your doctor inserts a catheter through a small cut in your leg or groin area.
2. The catheter is directed through your LAD and a small balloon on the catheter’s end is inflated to help clear the blockage. These first two steps are called angioplasty.
3. Your doctor inserts a stent, a small metal tube made of tiny meshed wires, to help keep your LAD open so that blood can pass through and continue restoring oxygen to your heart muscles.

Your doctor may insert a long-term stent to prevent the artery from getting clogged again. Some of these remain in the artery permanently, but other may be designed to dissolve over time so that your artery returns to a normal state.

Based on your recovery from the heart attack, your doctor may suggest heart surgery. You may also need heart surgery if your doctor finds blockages in multiple arteries around your heart.

Some surgery options include:

• Atherectomy. This is exactly like an angioplasty except that the catheter has tiny, rotating blades to clear away plaque buildup.
• Bypass. Your doctor uses healthy veins or arteries from other parts of your body to move the blood through a new blood vessel around the blockage.
• Valve replacement. Your doctor uses a healthy heart valve, often from a human donor or from cow or pig tissue, to replace a blocked or unhealthy valve.

If your LAD blockage is treated using angioplasty or stenting, you’ll usually need to spend at least one day in the hospital to recover. After that, you can go home and start doing normal activities again, such as going to work and exercising, after about a week.

If your doctor needs to perform heart surgery, you may need to spend three to seven days in the hospital before you’re cleared to go home.

You’ll likely wake up in the intensive care unit (ICU) with several tubes in your chest to drain fluids, an intravenous (IV) fluid tube in your arm to keep you nourished, and an electrocardiogram to keep an eye on your heart.

Once you get home, you’ll need to:

• Take care of your surgical incisions by keeping them warm, dry, and freshly bandaged a few times a day.
• Take any pain medications orblood thinners your doctor prescribes you.
• Avoid exercising or lifting anything over 10 pounds until your doctor says it’s OK to do so.
• Attend rehabilitation programs your doctor recommends to build up your heart’s strength and reduce your risk of having another heart attack.

Surviving the widowmaker is dependent on many factors, including:

• how quickly you’re treated
• what procedures are used
• whether your body goes into shock
• how your body recovers in the months and years following the heart attack

If you experience shock, your survival chances are around 40 percent. Without shock, your chances jump to about 60 percent or more.

And two crucial things to remember are that early diagnosis and prevention are paramount to not only preventing an LAD blockage but also increasing your chances of surviving one, especially in the long term.

Go to the ER right away if you notice any heart attack symptoms, and try some lifestyle changes either before or after having a heart attack to keep your heart healthy:

• Eat aheart-healthy diet of whole grains, healthy fats, low-fat dairy, and low sodium.
• Get plenty of exercise. Try light to moderate exercises for about 20 to 30 minutes a day.
• Stop smoking or using any kind of tobacco products.
• Keep your weight at an optimal level. Aim for a body mass index (BMI) of 25 or lower.
• Get plenty of regular, restful sleep, about six to eight hours a night. Try to go to bed and get up as close to the same time every day as possible.
• See your doctor or a cardiologist regularly to keep an eye on any early signs of heart disease or to make sure treatment’s working after a heart attack. Take any medications for your heart that your doctor recommends.

Last medically reviewed on October 29, 2018

How we reviewed this article:

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Why a ‘Widowmaker’ Heart Attack Is So Dangerous

Any heart attack can be fatal. But one particular kind has earned notoriety and a scary-sounding nickname because it is especially dangerous.

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You may have heard of the so-called “widowmaker” heart attack in the news or on a TV show. But what is it, and why is it called that? The answer starts with the particular artery that it affects.

Different kinds of heart attacks

There are three main arteries in the heart — one on the right side and two on the left side. (In case you need a refresher, the coronary arteries carry blood to all the regions of the heart to keep the muscle pumping faithfully.)

Heart attacks occur when blood clots form around plaque that builds on the walls of one or more of those arteries, blocking blood from flowing.

“If there’s no blood flow to the heart, the heart muscles become deprived of oxygen and vital nutrients and heart muscle damage starts immediately,” says cardiologist Penelope Rampersad, MD, MSc, FRCPC.

That’s what causes those classic heart attack symptoms like shortness of breath; cold sweats; and severe chest pain, tightness or pressure.

A widowmaker heart attack occurs when the left anterior descending (LAD) artery, which supplies blood to the larger, front part of the heart, is blocked at its origin.

“This artery delivers a major amount of blood to your heart,” Dr. Rampersad explains.

Because it serves such a big portion of the heart, the LAD artery is a particularly dangerous place to get a clot. A lot of damage can be done to the heart muscle if blood flow isn’t restored quickly.

But, you can’t tell that someone is having a widowmaker heart attack from the outside. It causes the same symptoms as a heart attack caused by a blockage in a different artery, including chest pain, chest heaviness, shortness of breath, lightheadedness and cold sweats. In women, the symptoms can be more subtle, like neck or jaw pain, nausea and lightheadedness.

What you should always do when you see someone having a heart attack – or if you think you might be having one yourself – is to get help immediately.

Action plan: Call 911

Every minute matters when someone’s having a heart attack. The longer blood isn’t reaching certain parts of their heart, the more the muscle will be damaged. The quickest way to get help is to call 911 – not to drive to the emergency room.

That’s because paramedics can begin diagnostics and treatment with clot-dissolving drugs en route, as well as feed information to the team at the hospital to help them prepare for the patient’s arrival.

“If the electrical system of the heart is affected, you might also experience rhythm problems,” Dr. Rampersad explains. “Defibrillation might be necessary, and that’s another reason why it’s best to call the paramedics.”

At the hospital, interventional cardiologists will determine where the blockage is and clear it using angioplasty and stenting, or bypass surgery.

Survival rates following a heart attack have improved in recent years; overall, nearly 90% of people who have a heart attack survive, according to the latest statistics from the American Heart Association.

The heart is resilient and might recover from a major heart attack like a widowmaker. Patients sometimes are released from the hospital within a few days — especially if they sought medical attention promptly and the cardiologists were able to open the blockages very early.

Sometimes, based on the extent of damage, the heart will heal by forming scar tissue, which doesn’t pump as well as healthy tissue.

Keepin­­­g your risk in check

When it comes to any kind of heart attack, “the best thing is prevention,” Dr. Rampersad says.

This means keeping your risk as low as possible by not smoking, being active, eating a heart-healthy diet and maintaining good sleep habits. It also means keeping conditions like diabetes, hypertension or high cholesterol under control.

If you experience any kind of chest pain, tell your doctor. It could be caused by a number of things, but it could also be an early sign of a heart problem.

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