What is a widow-maker heart attack, and why is it more dangerous than others?

Among the three blood vessels that supply blood to the heart, Left Anterior Descending (LAD) is the most important as it supplies blood to almost 60% of the heart. Due to this, heart attack involving blockage of the LAD carries the highest risk of death and disability. If not taken care of urgently, almost 50% of such patients will die within the first few days of the heart attack. Sometimes, the heart attack is so severe that patients succumb before reaching the hospital. Pre-menopausal women of age 50 or below are less likely to develop Coronary Artery Disease (CAD) or blockage unless they have risk factors like Diabetes, Smoking, a Family History of premature CAD etc. Hence, due to the higher likelihood of death in heart attacks involving LAD and the fact that blockages are seen more commonly in men, LAD is often called a 'Widow-maker' artery.

Blockages involving LAD are not exclusive to men. On the contrary, blockages are found more commonly in LAD than in other heart blood vessels. While pre-menopausal women are less likely to develop blockages in general, those who do develop blockages can very well involve the LAD. A heart attack involving LAD blockage has a similar outcome regardless of the gender of the patient. Few reports may suggest that while blockages/heart attacks are less common in women, they are more lethal.

It is important to note that CAD is less frequent in pre-menopausal women with no predisposing risk factors. However, younger women with traditional risk factors like Diabetes, high cholesterol, smoking, certain medical conditions, or family history where first-degree family members have had heart attacks or strokes at a young age have a higher predisposition to developing CAD. In such women, the risk of having a heart attack may be similar or higher than in men with no risk factors.

While blockages involving LAD are dangerous, we cannot ignore other blood vessels. For example, heart attack involving Right Coronary Artery (RCA) has a higher likelihood of needing a pacemaker, and those involving Left Circumflex (LCx) are more likely to lead to valve dysfunction. Either RCA or LCx blockages can also be life-threatening if not addressed expeditiously. Notably, symptoms alone cannot differentiate which blood vessel has blockages.

As a community, we should be vigilant in suspecting heart attacks in people with chest discomfort. Even a minor heart attack can lead to current abnormalities (arrhythmias) in the heart leading to death. A prompt evaluation and treatment may help save a life.

(The doctor is an MBBS (AIIMS), MD,DM (USA),FACC, Consultant Interventional Cardiologist, Kims Hospital)Dr Anoop Agrawal