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What Causes a Heart Attack?

What causes a heart attack and what should you do if you think you are having one?

By
Rob Lamberts, MD,
Episode #036

My last article covered how to know when chest pain is serious. Today I’m going to back up and discuss the disease that is the most common cause of the chest pain you should worry about: coronary artery disease.

What Causes a Heart Attack?

The coronary arteries are the blood vessels that supply blood to the heart. The heart’s job is to pump blood; the heart also needs its own blood supply to bring it oxygen and food. If that blood supply is cut off, the heart muscle cells can’t survive--they suffocate.

If that blood supply is cut off suddenly, it’s called a heart attack. Doctors call it a myocardial infarction, but you know how doctors are. The process that leads to the heart attack occurs over the course of many years, whereas the heart attack itself can kill in seconds. Here are the 3 steps that lead to a heart attack.

Step 1: Fatty Blisters Form

The first thing that can lead to an eventual heart attack is the formation of fatty blisters on the inside of the coronary blood vessels. These blisters are part of what is known as atherosclerosis, which means “scarring of the arteries.” You probably have heard these blisters called “cholesterol plaques” or “fatty deposits.” Why do these plaques form? The consensus among those smart scientists is that they are the result of a number of things, including: high blood pressure, toxins from cigarettes, high LDL cholesterol (which is the bad cholesterol), and diabetes. Some people are predisposed to atherosclerosis, presumably because the walls of their blood vessels don’t function properly, and so form plaques more easily. Age is also an important factor, as even smaller trauma to the blood vessels will mount up over time.

The big event in a heart attack is when a blister in the coronary artery bursts. Upon rupture, the substance in these plaques causes a blood clot to form, which blocks off the flow of blood in the artery

There are a lot of other factors involved, like inflammation, chemicals, and probably some covert conspiracy of big business and the CIA (as is the case in most areas of life); but I’m going to leave the fancy scientific stuff to those smart scientists. What you need to know is that these fat-filled blisters form over a number of years, and the best way to prevent a heart attack is to prevent these plaques from forming

Step 2: The Blister Bursts

The big event in a heart attack is when a blister in the coronary artery bursts. Upon rupture, the substance in these plaques causes a blood clot to form, which blocks off the flow of blood in the artery. The heart muscle downstream from the blood clot gets starved for oxygen, and this is what causes the chest pain. Depending on which coronary blood vessel is blocked, and how far upstream the blood clot occurs, the clot may threaten to kill a small amount of heart tissue, or nearly the entire heart.

What exactly causes this fatty blister to burst? A lot of times, we don’t know what brings on the final event, but intense exercise--especially in people who are out of shape--as well as other stressors on the body, such as infection, can cause plaque rupture.

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About the Author

Rob Lamberts, MD
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