The Widowmaker Heart Attack Explained
Heart Health
April 03, 2018
The Widowmaker Heart Attack Explained
Man on stretcher in ambulance
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Neeraj Badhey, M.D., Interventional Cardiology

Although it may seem impossible to survive something dubbed the “widowmaker,” Neeraj Badhey, M.D., an interventional cardiologist on the medical staffs at Texas Health HEB and Cardiac & Vascular Center of North Texas, a Texas Health Physicians Group practice, says that due to advancements in medicine and current gender neutrality when it comes to heart attacks, the title has become a bit of a misnomer.

“It’s called a widowmaker because it creates widows. It doesn’t mean it only affects men; it affects women too, but historically, men have been more prone to heart attacks than women, so the name has just been carried on for many decades,” he says. “So if a guy gets a blockage in that artery and doesn’t survive, it creates a widow, hence the ‘widowmaker.’”

How does a widowmaker differ from a regular heart attack? It’s all about the amount of blockage and where the blockage occurs in the heart.

There are three arteries that run over the surface of the heart and supply it with blood: the right coronary, the left anterior descending (LAD) and the left circumflex. The LAD runs down the front of the heart and supplies the front and main wall with blood. In a widowmaker (proximal LAD lesion) heart attack, the main artery is totally blocked right at the beginning of the blood vessel.   

“The widowmaker is when you have a very, very tight blockage in one of the main arteries that supply the majority of the heart muscle,” Badhey explains. “Typically if you have a blockage in one of the other arteries, it’s still bad but the other arteries can take over, but when you have a blockage in the LAD that supplies the majority of the heart, sometimes people don’t survive that, and that’s why it’s called the widowmaker.”

Badhey says a widowmaker is one of the more serious types of heart attacks, but it is treatable in many situations. The key is getting medical help quickly.

“Time is muscle. Once the patient comes through the door of a health care facility, and is identified as having a heart attack, the clock starts then,” Badhey says. “The goal across the country is to try and get that artery opened within 90 minutes. So that includes getting the patient to the cardiac catheterization laboratory and getting the catheter in the artery and opening it up. It’s called the ‘door to balloon time.’ The key is to open it up as soon as possible before it’s caused significant damage.”

A widowmaker presents with the same symptoms as a heart attack, which include:

  • Chest discomfort. Pain that radiates from the center of the chest and lasts more than a few minutes, or goes away then comes back. Can also present with uncomfortable pressure, a squeezing feeling or a feeling of fullness.
  • Discomfort in other areas of the body. Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  • Shortness of breath with or without chest discomfort.
  • Other symptoms can include nausea, indigestion, lightheadedness, fatigue or breaking out in a cold sweat.

Although it’s hard to distinguish a widowmaker heart attack from another type of heart attack from symptoms alone, Badhey says the symptoms are usually more pronounced in those experiencing a widowmaker.

A widowmaker heart attack also shares similar risk factors with any other type of heart attack, including:

  • Smoking
  • Diet
  • Age; 45 or older for men and 55 or older for women
  • Exercise
  • High blood pressure
  • Obesity
  • Uncontrolled diabetes
  • Family history

If you’re a fan of the popular television show ‘This is Us,’ then you know that the patriarch of the show, Jack Pearson, dies of a widowmaker heart attack after surviving a house fire. Jack was a relatively young, healthy man who didn’t present with any of the above symptoms immediately after being checked out by paramedics outside of his home. Then much later, he went from speaking to a doctor at the hospital to being pronounced dead, something that Badhey says would most likely never happen.

“It’s really rare that someone literally has a heart attack right in front of you and you can’t save them. Most heart attack patients die because you can’t get to them in time,” Badhey explains. “And they gave up on him very, very early; they didn’t spend enough time to try to recover him.”

In the show, Jack’s wife, Rebecca, stepped away for a few minutes to make a quick phone call and to grab a bite to eat from the vending machine, and within that time, Jack had undergone a heart attack, doctors and nurses tried to revive him, then shortly afterward the doctor was walking out to tell Rebecca the bad news. Before you start to panic, Badhey says that would also not happen in reality.

“Typically, we spend an hour, or an hour and half sometimes, trying to get these patients back. You can definitely get these people back, and there’s no better place to be when having a heart attack than in a hospital. So that didn’t add up,” he says.

As for the smoke inhalation causing Jack’s heart attack, Badhey says it’s not completely impossible, but smoke inhalation on its own isn’t a likely cause for a widowmaker.

“The smoke inhalation may have unmasked an underlying issue. But if it unmasked it, he would’ve had the heart attack right around the time he was in the house or in the ambulance; you don’t typically get better and then suddenly have a heart attack a couple of hours later,” Badhey says. “Theoretically it’s possible. Once you inhale a lot of smoke, it makes it harder for your blood to carry oxygen throughout the body and it places a lot of stress on the body, specifically on the heart, but once he got removed from the smoke and it’s not an active exposure, that risk goes away.”

If you’re a fan of the show, then you know scenes are shot throughout multiple decades to highlight what exactly the family has gone through up until the present day. Jack’s heart attack would’ve happened around the late ‘90s, in which Badhey said could be a contributing factor as to why Jack’s symptoms went unforeseen.

“In the early nineties, we didn’t know as well that time was muscle and we didn’t have the technologies to be able to salvage the muscle as quickly and as easily,” he says. “Now we have very good technology and equipment to be able to go in and open these arteries up on a fairly quick basis. The mid-nineties was really the developing era of this, but now we’ve learned a lot and we’ve learned two things: time is muscle—there’s no question about it—and to get to these people as quickly as possible.”

Unfortunately for Jack, and for fans of the show, it seems like smoke inhalation wouldn’t have actually caused his widowmaker in reality, or at the very least if this had happened in today’s time, doctors would have been able to possibly save his life. But we can sigh in relief, knowing that something dubbed the “widowmaker” doesn’t always have to be fatal.

If you think you or a loved one is experiencing a cardiac episode, it’s always best to seek medical attention right away. Even if you’re unsure it’s a heart attack, have it checked out to be sure. As Badhey mentioned, time is muscle and every minute matters.

Calling 911 is almost always the quickest way to get treatment, since emergency medical staff can begin treatment as soon as they arrive versus being driven to the hospital, which can be slowed down by traffic or traffic lights.

Learn more about your heart health or find a heart and vascular specialist near you.

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