What Is Widowmaker Heart Attack

Does this type of heart attack only affect men since it’s called ‘’widowmaker’’? Why is blockage of the LAD artery a significant, serious, and deadly problem? Can widowmaker heart attack be prevented? Eager to have these questions and more answered? Keep reading! 

Introduction

A widowmaker heart attack is a type of heart attack caused by complete blockage of the left anterior descending (LAD) artery, which provides over 50% of the heart’s blood supply. The LAD artery pumps blood to the left ventricle which in turn sends blood to the aorta and to the rest of the body.¹ 

Significance and seriousness of a widowmaker heart attack

A Widowmaker heart attack is considered a medical emergency because blockage of the LAD artery means that the heart muscle and body do not get enough blood, which can result in immediate, sudden death if not treated promptly.¹ 

Causes 

Widowmaker heart attack is caused by two main factors:¹

1. Atherosclerosis: plaque buildup (accumulation of cholesterol and fatty deposits) in the LAD artery can result in its full blockage
2. Blood clots: the LAD artery can also become blocked by a blood clot 

Risk factors

The term ‘’widowmaker heart attack’’ may make it seem as if it only affects men and people assigned male at birth (AMAB), but this is actually not the case. In fact, women and people assigned female at birth (AFAB) are at risk of developing widowmaker heart attacks as well.¹

Interestingly, age appears to be a bigger risk factor than sex and the age at which either sex has a higher risk differs. For example, the risk of developing widowmaker heart attack increases in men and AMAB after 45 years of age, but in women and AFAB after 50 years of age.¹ 

In addition to age, other risk factors of widowmaker heart attack include:¹

• Family history of heart disease
• Tobacco use
• Sedentary lifestyle: caused by lack of exercise and physical activity 
• Poor diet
• Medical conditions: including obesity, diabetes, high blood pressure (hypertension), and high cholesterol (hypercholesterolemia) 

Signs and symptoms

Widowmaker heart attack gives rise to the following signs and symptoms:¹

• Chest pain
• Shortness of breath
• Dizziness 
• Lightheadedness 
• Tiredness 
• Nausea 
• Pain in the left arm, neck, or jaw 

Diagnosis

A healthcare provider will diagnose a suspected patient with widowmaker heart attack by performing a series of tests in the following order:¹ 

1. Physical examination and medical history
2. Diagnostic tests including:²
   • Electrocardiogram (ECG or EKG): this is usually the first test performed to provide a diagnosis for widowmaker heart attack. An ECG or EKG involves attaching sticky patches (electrodes) to the patient’s chest, arms, and legs to monitor the heart’s electrical signals, which are displayed as waves on a monitor. It helps health professionals determine whether the patient had or is having a widowmaker heart attack 
   • Blood tests: these can be helpful to check certain proteins (cardiac markers) which usually leak into the blood after a widowmaker heart attack 
   • Echocardiogram: an ultrasound which uses sound waves to scan the heart and check for signs of heart damage 
   • Coronary Angiography: involves inserting a long, thin tube (catheter) into an artery that is usually present in the leg and through the heart. A dye is added to the catheter to help visualise the arteries during the test 
   • Chest X-ray: to check the heart’s size and condition 
   • Imaging tests such as cardiac computed tomography (CT) or heart magnetic resonance imaging (MRI): both tests provide detailed images of the heart and chest. However, how the images are provided differs between both tests. A cardiac CT scan uses X-rays whilst a heart MRI uses a magnetic field and radio waves

Either imaging test can be used to diagnose a widowmaker heart attack and both are helpful in identifying the severity of heart damage  

Management and treatment

The main current management and treatment options for widowmaker heart attack include:¹

• Oxygen mask: This is provided immediately to a person who has recently experienced a widowmaker heart attack to restore oxygen levels
• Medications such as:² 
  • Aspirin: to help reduce blood clotting
  • Thrombolytics or fibrinolytics: referred to as ‘’clot busters’’, these medications help break down blood clots that block the LAD artery and induce a widowmaker heart attack 
  • Heparin: a blood thinner or anticoagulant that prevents blood clotting. Heparin may be provided via intravenous (IV) injection
  • Nitroglycerin: used to widen blood vessels and increase blood flow to the heart. It may be provided as a pill (for under-the-tongue use or to swallow) or as an injection 
  • Morphine: this is usually provided when patients experience chest pain (angina) that is not relieved by nitroglycerin 
  • Beta-blockers: these help decrease blood pressure and slow down the heart rate. They are provided to people who experience any type of heart attack as they can help decrease both the severity of heart muscle damage and the risk of developing future heart attacks 
  • Statins: help decrease the levels of low-density lipoprotein (LDL), which is the ‘’bad’’ form of cholesterol that clogs arteries  
  • Angiotensin-converting enzyme (ACE) inhibitors: these blood pressure medications decrease blood pressure 
• Cardiac rehabilitation (rehab): this involves a personalised and tailored exercise, diet, and stress management programme. Patients usually start cardiac rehabilitation in the hospital and continue for weeks to months after returning back home

Patients who recently or previously experienced a widowmaker heart attack are advised to attend cardiac rehabilitation as it can decrease their risk of developing further heart attacks in the future and help them live longer. 

• Surgical procedures such as:²
  • Coronary angioplasty and stenting: also called ‘’percutaneous coronary intervention (PCI)’’, this surgical procedure is performed to open a blocked LAD artery 
    • During coronary angioplasty, a cardiologist (heart doctor) will insert a catheter into the narrowed part of the LAD artery. A balloon is then inflated to help widen the blocked LAD artery and increase blood flow to the heart
    • A small mesh tube (stent), which may be coated with a medication that widens arteries, is typically also inserted to keep the LAD artery open
  • Coronary artery bypass grafting (CABG): CABG or ‘’open-heart surgery’’ is a surgical procedure where a surgeon takes healthy blood vessels from other parts of the body including the legs and uses them to create a ‘bypass’ in order for blood to get around the blocked LAD artery

Complications 

If left untreated, a widowmaker heart attack can lead to severe and life-threatening complications including:² 

• Irregular or atypical heart rhythms (arrhythmias): these cause changes to the rate or rhythm of the heartbeat which can be deadly
• Cardiogenic shock: this occurs when the heart is suddenly unable to pump sufficient blood and oxygen to the body which can lead to organ failure and eventually, death
• Heart failure: this occurs when the heart is unable to pump enough blood to the body due to damaged and weakened heart muscle tissue. Heart failure often leads to cardiogenic shock
• Pericarditis: also known as ‘’Dressler syndrome’’, ‘’postmyocardial infarction syndrome’’, or ‘’post cardiac injury syndrome’’, pericarditis occurs when the pericardium, which is a sac-like tissue that surrounds the heart, becomes inflamed 
• Cardiac arrest: this is when the heart suddenly stops beating, resulting in immediate death without warning 

Prevention strategies 

Despite its severity, the risk of developing widowmaker heart attack can be lowered by adhering to the following prevention strategies:¹

• Eating a healthy and balanced diet low in saturated fats: foods high in saturated fats that should be limited include eggs, palm oils (e.g. coconut oil), meat, and full fat dairy (e.g. butter, cheese etc.) 
• Engaging in regular physical activity: at least 150 minutes a week of moderate physical activity (e.g. walking) is recommended to keep the heart healthy 
• Decreasing and limiting sugar intake
• Avoiding tobacco use
• Maintaining a healthy weight: if struggling with obesity, consider losing weight 
• Managing medical conditions: such as diabetes, high blood pressure, and/or high cholesterol 
• Managing stress levels: stress can put extra pressure on the heart which may trigger a widowmaker heart attack. Consider incorporating stress-relieving activities into your daily routine such as yoga, meditation, and/or deep breathing exercises 

When to see a doctor?

Call 911 immediately if you think you are, or someone else is, experiencing a heart attack.² 

Do not delay the call for any reason as each minute after a heart attack, the heart muscle tissue undergoes more damage. The damage may be irreversible or even deadly. 

Summary 

Widowmaker heart attack is a type of heart attack that occurs when the left anterior descending (LAD) artery becomes completely blocked due to blood clots or atherosclerosis (plaque build-up). The LAD artery provides over 50% of the heart’s blood supply. Therefore, its complete blockage causes the body to become deprived of oxygen-rich blood, which can lead to sudden cardiac death (cardiac arrest), if not treated promptly. 

Despite being coined ‘’widowmaker’’, widowmaker heart attack does not only affect men but women as well.

People who are sedentary, eat a diet high in saturated fats, and smoke regularly are at significant risk of developing widowmaker heart attacks. Therefore, widowmaker heart attacks can be prevented by avoiding these unhealthy behaviours. 

An electrocardiogram (ECG or EKG) is the primary diagnostic test for widowmaker heart attack. However, other valuable diagnostic tests for widowmaker heart attack include: 

• Blood tests
• Echocardiogram
• Coronary Angiography
• Chest X-ray
• Imaging tests e.g. cardiac computed tomography (CT) or heart magnetic resonance imaging (MRI)

At present, management and treatment for widowmaker heart attack include: 

• Oxygen mask 
• Medications e.g. beta blockers or statins
• Cardiac rehabilitation (rehab)
• Surgery e.g. coronary angioplasty and stenting or coronary artery bypass grafting (CABG)

Call 911 immediately if you experience any of the signs and symptoms of widowmaker heart attack including: 

• Chest pain
• Shortness of breath
• Dizziness and/or lightheadedness 
• Tiredness
• Nausea  
• Pain in the left arm, neck, or jaw