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What is a Heart Attack?

A heart attack (also called “myocardial infarction”) occurs when a blood vessel supplying blood to a part of the heart becomes blocked, resulting in permanent damage to the heart muscle due to the lack of blood flow. The blood vessel can become blocked from advancing atherosclerotic plaque lesions, a sudden formation of a blood clot, or from the spasming of a coronary artery - an artery that supplies blood to the heart.

Most people believe that a heart attack is caused by a slow, progressive build-up of plaque, comforting themselves that it takes a lifetime to become completely clogged - but this just isn't true for a majority of heart attacks. Heart specialists now believe that most heart attacks occur when an unstable, atherosclerotic plaque lesion, filled with cholesterol and fat, suddenly breaks apart, thus forming an open wound within the artery wall. Blood platelets and clotting proteins rush to the wound and form a clot — called a thrombus. The clot can enlarge in a matter of moments, causing obstruction of blood flow to the heart with resultant angina (chest pain). If the blood flow becomes completely obstructed, a heart attack ensues.

Surprisingly, it is the small plaques that can be the most lethal. A person with a 50% blockage who suddenly becomes obstructed is at much greater risk of having a large amount of heart damage than a person with a slowly progressive blockage. A person with a 90% blockage that was slow to progress has probably had a chance to develop “collaterals”–– smaller blood vessels that grow to take over the job of the big vessel that has been gradually closing down.

Every Second Counts
A heart attack is a life–threatening event. With immediate medical intervention — preferably within the first hour of onset of symptoms – heart damage may be averted or reduced. A new blood test measuring “troponin” – a chemical released into the blood during a heart attack – allows doctors to diagnose a heart attack more quickly and accurately than ever before. Time equals muscle is the theme that resounds in emergency rooms and treatment is aimed at quickly restoring blood flow to the heart muscle to prevent permanent damage.

Studies show the most common time for a heart attack to occur is Monday morning. Saturday morning ranks second. Another common time is during the early morning hours when the platelets are stickier. Aspirin reduces platelet stickiness. Aspirin can also reduce the amount of damage caused by a heart attack in progress. Aspirin can have side-effects, however, and preventive “aspirin-a-day” therapy is reserved for those at risk. Check with your doctor or healthcare professional if regular aspirin may be of benefit to you.

In his book, The McDoughall Program for a Healthy Heart , author John McDoughall, MD, outlines the following key elements that can lead to a heart attack:

  • The presence of high total cholesterol and LDL cholesterol
  • The initial injury to the lining of the artery wall
  • The formation of unstable, cholesterol–filled, fat–filled plaques
  • The rupture of the plaque
  • The formation of a clot over the open plaque
  • The clot closing off blood flow to the heart or brain (or other major organ), causing a heart attack or stroke.

What sets these elements in motion? Dr. Mehmet Oz, MD, heart surgeon at Columbia Presbyterian Medical Center in New York City, stated at a recent conference on the Mind-Body Connection (Friends Connection, Mar,00, Moorestown, NJ) that it is his observation that many heart attacks can be traced back to a very stressful life event that occurred about four to seven days prior. Dr. Oz says that there are still many unknowns about what causes a disease state. In any case, something happens to cause a turbulent blood flow and the platelets to become very sticky. In his book, Healing from the Heart, Dr. Oz further explains the biophysical changes that contribute to the unstable plaque and rupture, also explaining why smaller lesions are the most dangerous.

"The surface of the plaque is very active and tends to be irritable. If a lot of blood elements, including sticky platelets, adhere to this surface, a fifty to sixty percent lesion can suddenly grow in size and close off all passage of blood. The plaque, like a balloon, can also fill itself with blood, expand and plug the vessel”.

Dr. Oz explains in his book that the physiological makeup of troubled arteries is an important factor in evaluating heart disease. To illustrate, Dr. Oz compares a very elderly woman with a 50% blockage who has no chest pain and slowly advancing atherosclerosis, to a young man with a 50% blockage who has chest pain with minimal exertion. The etiology (cause) of heart disease is different in these two persons. The treatment will be different. “It all depends on how pliable— how spasm-prone –a patient’s vessel walls are”.

Scenario of a Heart Attack
Below is a passage that describes a heart attack that occured to a fictitious patient named “Frances” and represents a composite of several women heart attack sufferers. It was adapted, in part, from Dr. Oz's book, Healing from the Heart. The story illustrates how heart disease can present in a woman, the nature of the disease, and how a person's life hangs in the balance. It is important to note that heart attack treatments vary from hospital to hospital, depending upon the technology available at the institution. Hospitals that specialize in open-heart surgery are able to offer some of the more advanced cardiac care services and procedures.

One Woman's Story - the story of Frances
Sixty-year-old Frances had been feeling poorly for the past two weeks with feeling run down. Symtpoms worsened over that period and she was feeling extreme weakness and looking especially pale. She figured she must be coming down with the flu, but it didn't feel like the flu. By Sunday afternoon, however, her symptoms became life-threatening. She developed a crushing, vise–like pressure in her chest that took her breath away. The pain was shooting down her left arm and through to her back. She could barely talk or breathe and she couldn't even lift her arms to pick up a toothbrush, let alone a phone to call 9-1-1.

Frances lived alone and she was paralyzed with fear. She didn't want to go to the hospital by ambulance and she didn't want to disturb her friends on a Sunday evening because “they were busy with their own lives and had their own set of problems”. She convinced herself that if she took two aspirin and went to bed, she would be better in the morning... but that's not what happened. Her sleep was interrupted with recurrent chest pain. At dawn, Frances called her best friend, Anne, who immediately came to her rescue and drove her to the nearest hospital emergency room.

By the time Frances reached the hospital, precious minutes had been lost while the affected part of her heart muscle was dying. An electrocardiogram was completed, a potent pain medicine administered, an intravenous line started and a blood test taken. Immediately after the emergency room doctor made a diagnosis of heart attack, Frances received a potent blood thinner to try and dislodge the clot. When this failed, a dye was injected into her heart arteries through a catheter inserted into her groin's large femerol artery. A moving X-ray image on film—an angiogram— was then made of Fran's heart in full, crippled action, showing one major and several smaller blockages. The first–line doctors decided against angioplasty due to the location of the blockages. Angioplasty is a procedure whereby a tiny balloon near the end of a catheter is placed into the blocked artery and inflated, flattening the clot and the plaque and opening the vessel. With angioplasty no longer considered an option, open-heart bypass surgery was being considered. Her cardiologist then came in to discuss all treatment options and related risks so that she could make an informed decision.

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1999-2000; updates: 2002, 2004, 2005, 2007 Women's Heart Foundation, Inc. All rights reserved. Unauthorized use prohibited. The information contained in this Women's Heart Foundation (WHF) Web site is not a substitute for medical advice or treatment, and WHF recommends consultation with your doctor or health care professional.