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Posted on Monday July 31, 2023 in Heart Health
Written by Dr Edward Leatham, Consultant Cardiologist
A heart attack, or myocardial infarction, is a life-threatening event that causes sudden death or an acute life-threatening illness.
While coronary heart disease is a well-known cause of heart attacks, there are other conditions that can contribute to this critical health crisis. In this article, we will explore 10 causes of dying or being damaged by a heart attack, shedding light on various underlying factors that can lead to this cardiovascular emergency.
1. Coronary Heart Disease Causing Coronary Thrombosis- the most common cause.
Coronary heart disease (CHD), often referred to as atherosclerosis, is the leading cause of heart attacks. It occurs when plaque build-up narrows the coronary arteries, reducing blood flow. A heart attack can result if a blood clot (coronary thrombosis) forms in these narrowed arteries, completely blocking blood supply to a portion of the heart.
Coronary heart disease is widely prevalent and a leading cause of death in western world. It can be detectable from 30 yrs upwards and remain silent for many years before symptoms develop- on over half those affecting the first being a heart attack or sudden death. These facts and its toll on so many families and people have led to a huge effort in detection and prevention programs globally, in particular the use of modern CT and AI techniques to help detect those most at risk.
2. Embolism from Atrial Fibrillation
Atrial fibrillation (AFib) is a common heart rhythm disorder characterized by irregular and often rapid heartbeat. In AFib, blood can pool in the atria, leading to the formation of clots. If one of these clots dislodges and travels to the coronary arteries, it can cause an embolism, obstructing coronary artery blood flow, causing a heart attack.
Not everyone affected with AFib has symptoms, which is why pulse and ECG checks (that people can do for themselves) are now recommended in anyone over the age of 50.
3. Pulmonary Embolism
Although not typically associated with heart attacks, acute massive pulmonary embolism causes chest pain and circulatory arrest. Pulmonary embolism occurs when a blood clot from another part of the body, often the legs, travels to the lungs. The strain on the heart to pump blood through obstructed lung arteries can contribute to heart damage or failure.
There are many inherited conditions causing an increased tendency to form blood clots which is why people with a family history of blood clots and/or pulmonary embolism should consider getting themselves screened, as if affected, simple measures and the taking of anticoagulant drugs during periods of high risk can prevent devastating a pulmonary embolism or heart attack.
4. High Blood Pressure Causing Heart Failure
Long standing high blood pressure, or hypertension, forces the heart to work harder to pump blood throughout the body. Over time, this extra strain can weaken the heart muscle, eventually leading to heart failure. In some cases, the increased workload on the heart can precipitate a heart attack.
5. Viral Myocarditis
Myocarditis is inflammation of the heart muscle, often caused by viral infections. When the heart muscle becomes inflamed, it can weaken and disrupt the heart’s normal functioning, potentially leading to a heart attack if blood flow is compromised.
Viral myocarditis can present with non-specific symptoms however a 12 lead ECG and some simple blood tests such as BNP and Troponin leading to an Echocardiogram and Cardiac MRI scanning are useful tools in making the diagnosis.
6. Arrhythmia from Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy (HCM) is a genetic condition characterized by the thickening of the heart muscle. This thickening can disrupt the heart’s electrical signals, leading to arrhythmias (abnormal heart rhythms). Severe arrhythmias can reduce blood flow to the heart, triggering a heart attack.
7. Inherited or Drug-Related Long QT Syndrome and other channelopathies
Long QT syndrome is an inherited or drug-induced condition that affects the heart’s electrical activity. It can cause chaotic heart rhythms that, in some cases, may lead to a heart attack. Individuals with long QT syndrome are at higher risk, particularly when exposed to certain medications. Brugada syndrome is another inherited condition that affects the heart’s electrical system. It can lead to sudden arrhythmias and an increased risk of cardiac arrest, which can result in a heart attack or severe damage to the heart muscle. These rare and specialist conditions can be identified and treated by a cardiologist.
9. Congenital Heart Disease Causing Heart Failure
Congenital heart defects are present at birth and can vary in severity. Some congenital heart diseases can lead to chronic heart failure if left untreated. Heart failure can exacerbate the risk of heart attacks, especially if the blood supply to the heart is compromised.
10. SCAD (Spontaneous Coronary Artery Dissection)
Spontaneous coronary artery dissection (SCAD) is a less common but increasingly recognized cause of heart attacks, especially in young and otherwise healthy individuals, primarily women. SCAD occurs when a tear forms in one of the coronary arteries, often leading to a heart attack.
11. Takotsubo Cardiomyopathy
Takotsubo cardiomyopathy, also known as “broken heart syndrome,” is a condition in which severe emotional or physical stress can cause the heart muscle to weaken temporarily, mimicking the symptoms of a heart attack. While the exact cause of Takotsubo cardiomyopathy is not fully understood, it can lead to heart damage and, in rare cases, even heart attacks.
Conclusion
Heart attacks are complex medical events that can result from a variety of underlying causes and conditions. While coronary heart disease remains a major contributor, it is crucial to recognize the numerous other factors that can lead to heart attacks. These include arrhythmias, inherited conditions, infectious diseases, and even congenital defects. Identifying and addressing these underlying causes can play a critical role in preventing heart attacks and minimizing their damage.
I explore ways of detecting and preventing three of the most common causes in a separate article however, regular medical check-ups, a healthy lifestyle, and genetic screening can also all aid in early detection and intervention, potentially saving lives and reducing the risk of heart attack-related complications.
The idea of predicting a heart attack may have once seemed like science fiction, but it is rapidly becoming a reality. With the advent of advanced imaging techniques and artificial intelligence, we are now able to detect the early signs of coronary heart disease and intervene before a heart attack occurs. This represents a major shift in the way we approach cardiovascular care, moving from a reactive model to a proactive one.
Is is increasingly obvious that not everyone with raised coronary inflammation and elevated risk of heart attack simply has a raised LDL Cholesterol- in fact there appears to be a mixed bag of risk factors associated with high coronary artery inflammation, including raised LDL, raised LP (a), raised Homocysteine, hypertension and dysregulated glucose. Our metabolic health assessment is therefore designed to offer a comprehensive dive into known contributory causes, the latest and most controversial of which is 'glucose dysregulation', the principle topic of this article.
For patients who have been diagnosed with an acute coronary syndrome, requiring bypass surgery or stent, or have CT Angiography and or raised FAI.
Ultimately, the approach to cardiac CT screening is highly individualized, reflecting the diverse presentations and risk factors among patients. By employing a sophisticated pre-consultation process, cardiologists can tailor their assessment and management plans to best suit each patient's unique needs, enhancing the precision and effectiveness of cardiac care.
There are two main reasons left atrial thrombus forms then detaches to cause embolic stroke. The first is that during atrial fibrillation or flutter, a thrombus may develop in the left atrial appendage, which does not move as much as it does when in sinus rhythm. The likelihood of this occurring in any given year is low, correlated to the CHA2DS2-VASc score. The second reason is not related to CHA2DS2-VASc score
A new high quality MRI scanning service launched today by VCL and available at SCVC.
The start of a series of simple video explanations covering all of the main common medical conditions that can affect us, as we age.
Written by Dr Edward Leatham, Consultant Cardiologist: with the right approach and self-monitoring, you can take charge of your heart health and effectively manage your AF.