On the Clock: Surviving “the widowmaker” and Heart Attacks 101

Interventional Cardiologist Randy Goodroe says patients are getting treatment much quicker for heart attacks now than ever before. So the once grim reality of suffering from “the widowmaker” – a heart attack that results in immediate death – has become somewhat of a misnomer.

“The widowmaker occurs when the left anterior descending artery, the most important artery in the front of the heart, is totally blocked,” said Dr. Goodroe, the chest pain director at Grand Strand Heart & Vascular Care at HCA Healthcare’s Grand Strand Medical Center. “When this happens, the whole front wall of the heart isn’t getting any blood or oxygen.”

It’s called a “widowmaker”, Dr. Goodroe added, because it would typically kill you if the artery doesn’t get opened fast enough.

That’s why a patient who visits the emergency room at the Myrtle Beach, S.C. hospital with a completely blocked artery typically will be treated within 30 minutes of their arrival.

“The widowmaker isn’t nearly as widow-making as it used to be, thanks to the public being so well educated on the symptoms of a heart attack and the quick diagnosis and treatment in the ER.”

Dr. Babu Makkena, an interventional cardiologist at Medical City Lewisville, another HCA Healthcare affiliate in North Texas, recently helped save the life of a high school teacher after he suffered from “the widowmaker” – a fully blocked left main artery.

He also noted that without the quick response and lifesaving actions of six students and three staff members, who performed CPR and used the school’s Automatic External Defibrillator (AED) to restore normal heart rhythm until paramedics arrived, the teacher may not have survived. Medical City Lewisville honored them for their heroic work at a high school pep rally.

Answering more of our heart concerns to raise awareness this American Hearth Month is Dr. Goodroe – an eight-year veteran at Grand Strand Heart. We started at the beginning…

What is the job of the heart?  

The heart pumps blood to the body and brain. The heart also needs blood so it pumps blood to itself, too. The heart’s blood supply is essentially three main arteries: one that goes to the front; the other that goes to the back; and the final artery that connects to the side of the heart. When one of those arteries is blocked, the heart doesn’t get enough blood and oxygen, causing a heart attack. The exact same thing happens in the brain, which causes a stroke.

What are the different types of heart attacks?

There are two different kinds of heart attacks. One is called an ST-elevation myocardial infarction, or STEMI, where the artery is totally blocked (i.e. the widowmaker), and we are on the clock to get the artery opened as soon as possible. At Grand Strand, we treat approximately 25-30 patients per month who suffered from STEMI heart attacks. There’s also a non-ST-elevation myocardial infarction (NSTEMI) where an artery is partially or temporarily blocked, and is still urgent to get the artery cleared, but not emergent.

What are the symptoms of a widowmaker?

Unfortunately, not everyone has typical symptoms, but usually, when someone has a totally blocked artery, they are definitely experiencing signs like:

• Chest pain
• Chest pressure
• Chest tightness
• Shortness of breath

There are a lot of atypical symptoms, too, such as:

• Nausea
• Vomiting
• Sweaty
• Just not feeling ‘well’

Most people will know that something is not right. Anyone experiencing symptoms that mimic a heart attack should immediately call 911.

Are the symptoms different for women than men?

There are publications that say women more commonly have atypical symptoms. That’s probably true to some degree, specifically, for cases where the artery is partially blocked (NSTEMI). Most people have fairly typical symptoms if an artery is totally blocked (STEMI), however.

What are the common risk factors for heart attacks?

Age is definitely a risk factor. We start seeing coronary disease in people who are between 50 and 60-years-old, and obviously, the older the person, the older the arteries, the higher the risk. Diabetes is another one of the greatest risk factors. Smoking is the strongest modifiable risk factor, meaning it’s the worst thing people can do to themselves to accelerate the disease process. High blood pressure and family history are also risk factors for heart attacks.

Are there routine screenings or ways to prevent a widowmaker?

The best way to prevent any type of heart attack is diet, exercise and not smoking. As for screenings, we do perform stress tests for patients we suspect might have a problem.

How do you treat a widowmaker?

If a patient enters the ER with heart attack symptoms, we quickly perform an electrocardiogram (EKG) or heart tracing to detect a totally obstructed artery. Those patients are very quickly taken to the cardiac catheterization lab where we’ll use balloons and stents to get the blood flowing to the heart again.

The artery is like a pipe or a tube, so we put a tiny wire through the blockage, slide a balloon over the wire and blow it up to open the blocked area. Then we take the balloon out and slide over a stent – that also has a balloon on it – and once the stent goes up, it props open the blockage.

How important is the treatment time when caring for a heart attack patient?

When I started my medical training the treatment time was 120 minutes. During cardiology training that number decreased to 90 minutes. The gold standard now is to treat the patient in less than 60 minutes. The reason is, if an artery is closed for longer than 60 minutes the mortality rate starts to increase significantly. So if we can get that artery opened in less than 60 minutes then the associated mortality is much less.

What’s the recovery period for a patient after suffering a heart attack?

Most of our patients are going home the next day now. If they have been prompt and seek medical attention as soon as symptoms start, we are usually able to get that artery opened quickly before it causes any permanent damage. Then that patient should live a completely normal life moving forward.

Dr. Randy Goodroe is an interventional cardiologist at Grand Strand Heart & Vascular Care at Grand Strand Medical Center, an affiliate of HCA Healthcare. Visit here for more information on cardiovascular diseases during American Heart Month.