Hidden Heart Attack Trigger Found

Plaque disruption may cause unexpected heart attacks in healthy women

(RxWiki News) Heart attacks in patients considered low risk and otherwise healthy has long puzzled doctors. But now they may have identified a hidden culprit in women.

Plaque disruption, or a rupture of cholesterol plaque in a coronary artery, has been found to cause myocardial infarction, a common type of heart attack, in women without significant coronary artery disease.

"Go to the hospital immediately if you suspect a heart attack."

Dr. Harmony Reynolds, lead author, associate director of the Cardiovascular Clinical Research Center and assistant professor of medicine in the Leon H. Charney Division of Cardiology at New York University Langone, said that for the first time new research has shown that disrupted plaque is the culprit behind heart attacks in women who appear on an angiogram to have minimal or no coronary artery disease.

He said the findings show that such women can essentially have a heart attack just like patients whose coronary arteries show blockage on an angiogram.

Researchers enrolled 50 women with open coronary arteries in the study. Their arteries were viewed through angiography, using intravascular ultrasound and cardiac magnetic resonance imaging.

Investigators were able to identify plaque ruptures in some artery segments that appeared completely normal on the angiogram, using intravascular ultrasound to visualize the artery walls in more detail than conventional angiography.

They found that 38 percent of heart attacks in women with normal angiograms results originated from plaque disruption that could not be seen on an angiogram.

Dr. Reynolds said that as a result some women could be told they did not have heart attacks since their angiogram appeared normal, which could result in a heart attack going undiagnosed. Patients also would not receive life-saving medication that could protect them from future cardiac events.

"Patients and doctors both need to know there is a form of heart attack that can occur in which the arteries are not blocked on an angiogram," Dr. Reynolds said. "This is in fact a heart attack and steps need to be taken to prevent another cardiac event."

The clinical study was published in the Sept. 27 issue of the journal Circulation.

Review Date: 
September 28, 2011