Most people are surprised to learn that not every heart attack is caused by clogged arteries. Heart attacks happen when a portion of your heart is deprived of blood flow long enough to cause damage to the heart muscle. Classically, we think of that as a result of eating too many cheeseburgers and other high-fat goodies that cause plaque build-up inside arteries. When too much plaque accumulates, it can break off and form a clot that reduces blood flow to the heart, leading to a heart attack.
There are other reasons people can experience heart damage or a heart attack that you may not be aware of. As a physician, I've seen some of these in practice.
Here are five less-common causes of heart attack:
Coronary arteries are the blood vessels that supply blood to the heart. In a "classic" heart attack, one or more of these vessels is blocked by a plaque that ruptures and reduces blood flow to the heart, leading to heart damage. There's another way blood flow to the heart can be reduced: A coronary artery can spasm. This happens when a seemingly normal coronary artery clamps down or tightens so that blood flow to part of the heart is reduced. If this spasm isn't corrected, it can lead to death of a portion of the heart in the same way a classic heart attack can.
What causes a coronary artery to spasm? Some drugs and medications, including cocaine and amphetamines, can do it. When you hear about someone who had a heart attack after taking cocaine, that's usually the cause. Cigarette smoking also increases the risk of a coronary spasm. Less commonly, emotional stress or exposure to the cold can trigger spasm in a coronary artery. In some cases a spasm is short-lived without permanent damage, in others it damages a portion of the heart muscle.
Another less-common cause of heart attack is when the walls of a coronary artery develop a split or separation. This separation causes blood to flow abnormally to the heart, leading to heart damage. This type of heart attack is more common in females and is linked with hormonal fluctuations. Although not common, they occur more frequently around the time of a woman's period or immediately after pregnancy. Unlike a classic heart attack, coronary artery dissections can occur in women as young as their 20s or 30s. It can also be a result of trauma to the inside of a coronary artery when a catheter is put in during a diagnostic or surgical procedure.
Another uncommon cause of heart attack is blunt trauma to the chest wall, pelvis, or abdomen. In rare cases, this type of trauma causes a clot to form inside a coronary artery or forces the artery to separate or tear, leading to decreased blood flow to the heart. The most frequent cause is blunt trauma from an automobile accident where a person's chest hits the steering wheel, or a sports injury where an athlete gets hit in the chest.
Some people are born with coronary arteries that are congenitally abnormal. In some cases the abnormal coronary arteries put pressure on other blood vessels and decrease blood flow to the heart. People with this problem may not have symptoms, but when the requirement for blood flow and oxygen increases, like during exercise, the abnormal coronary arteries may not be able to meet the demand, leading to a heart attack or sudden death. Fortunately, this condition affects less than 1 percent of the population; however, it's one of the most common causes of heart attack in children.
The other most-common cause of heart attack in children is Kawasaki disease. Kawasaki disease is an autoimmune disease that affects children under the age of five. It causes lymph node inflammation and inflammation of blood vessels, including, in some cases, the coronary arteries that supply blood to the heart. This can damage the wall of the coronary arteries, leading to an out-pouching or aneurysm. When an aneurysm appears, blood clots can more easily form and reduce blood flow to the heart, leading to a heart attack. Fortunately, most children don't develop this serious complication, especially if they are treated early.
Not all heart attacks come from a poor diet and lack of exercise, although those certainly increase your risk. Any time you have chest pain, shortness, of breath or lightheadedness, seek medical attention right away.