She was a new patient to me. As we reviewed her history, I learned that she had had a well-documented heart attack with severe symptoms at the time. She was admitted to the hospital and when I got her records, they confirmed her history. Her blood tests and EKG proved that she had indeed had a heart attack. She had a heart artery catheterization afterwards that revealed heart arteries that were completely open. There was no blockage at all, and she had had no stent procedure to open the artery.
So how do we explain that? It is totally at odds with the way our healthcare system thinks about women with heart artery disease even now. Women are less likely than men to have local blockages of heart arteries. Their cholesterol deposits are more evenly spread out. They form small local abscesses like an inflamed pimple. When these burst or erode and expose raw tissue, that kicks off the clotting process. This woman formed a clot that totally blocked the artery cutting off the blood supply. That caused her heart attack.
Our bodies have clotting and anticlotting factors naturally. When an artery clot forms, natural anticoagulants try to break it down. There is a balance between clotting and anticlotting. Her clot lasted long enough to cause a heart attack and then her natural anticlotting factors dissolved it. Individuals with cholesterol deposits rupture these pimples quite often. Most of them do not cause a heart attack because our anticlotting factors win, and the artery is not completely blocked. This also explains a condition called unstable angina or unstable chest pain. A patient with stable chest pain with walking six blocks may develop chest pain at rest or with minimal exertion. That change in the pain is caused by a war between clotting and anticlotting. If clotting wins, and the artery is completely blocked, that causes a heart attack.
In this case, in the unstable patient where a heart artery is completely blocked by a clot, a stent and anticlotting medications can be lifesaving. When unstable angina is recognized, a stent in the partially blocked artery followed by anticlotting medications can abort the heart attack process. That is why it is so important to get to the hospital when there is a change in chest pain pattern. The sooner the heart artery is opened, the more heart muscle is saved.
All current conventional cardiology tests detect “late stage heart disease” structurally, with very little true functional physiological information. They DONNOT detect ANY early signs of the heart dysfunctions especially caused by infection, metabolic Insulin resistance, respiratory diseases, substance abuse, etc. Sadly, due to the lack of better functional physiological tests, these potentially dangerous diseases cause early deaths in people never suspected of heart diseases.
That’s one of the MANY causes of a heart attack, not the ONLY one. She was lucky to be tested “abnormal” on her EKG and blood tests. That’s an exception rather than the rule. However, in fact majority in our databases collected over two decades now, many women suffer a heart attack WITHOUT these “abnormal signals” at all. We need better tests, in conclusion. Let’s be honest about this and allow progress to succeed and to really improve women’s heart disease detections! Bill.