Traditional heart attacks attack male population generally and now the scenario seems to change gradually where researchers have discovered a heart condition called myocardial infarction with non-obstructive coronary arteries (MINOCA) which is more commonly present in females.
A completely blocked or severe narrowing of a heart (coronary) artery due to cholesterol plaque causes myocardial infarction (MI) (commonly called as heart attack). But, in 5-20% of cases angiograms reveal that the arteries are less than 50% blocked and termed as MINOCA.
Coronary artery spasm (CAS) is the most common epicardial cause of MINOCA. Existing at a localized segment of an epicardial artery, there might be multiple segments of the same artery involved or multiple different arteries involved.
Microvascular cause of MINOCA includes Takotsubo syndrome (TS). TS is predominantly present on post-menopausal females who suffer from physical or emotional stress. Coronary embolism is also included in microvascular causes of MINOCA. Here, the coronary artery appears abnormal due to abrupt vessel stump or some thrombotic material inside epicardial coronary artery. Paradoxical embolism (PE) is rarely a cause of MINOCA which is present when there is an arterial embolism without any source present in the left heart, embolism is present in the venous system and when there is a communication taking place between venous and arterial circulation.
Treatment depends on factors such as patient characteristics, time of occurrence and the presence/absence of embolic sites. Treatment is often missed in patients with MINOCA as many of them with angiogram-specific normal-coronary arteries are labeled as non-cardiac patients. This normally worsens the situation of the patient as treatment procedure is often delayed and inappropriate.
The Latest Study
A new study has found that 1 in 10 heart attacks in younger patients are not caused by blocked coronary arteries but experienced similar outcomes as those with heart attack whose common source is blockage. Such attacks are termed as MINOCA and research shows that women face 5-times higher risk of MINOCA compared to men.
The pity is that, even after one year of MINOCA, 5% of these patients suffered from yet another heart attack or died from heart attack. Patients with coronary artery have 9% chance of repeat death. MINOCA worsens with time, after 5 years 11% of these patients were affected again or died compared to 16% of patients with blocked arteries. While only 25% of regular heart attack patients are females, almost 50% of MINOCA patients are females.
The study collected data from 2,690 heart attack patients aged between 18 and 55 years of age. Data was collected from various sources, almost 103 hospitals. Any non-obstructive heart attack defines 6%-14% of all heart attacks and in this study, it contributed to as much as 11% of those analyzed.
MINOCA patients are mostly non-smokers and don’t possess most of the specific characteristics such as diabetes or high blood sugar that denote heart disease. Here, blood clotting was a regular affair when compared to heart attack patients whose artery stemmed from artery obstruction.
While causes are not known exactly, some common ones include a tear in the coronary artery wall wherein the blood is collected between the inner and outer layers of the body. Such blood collected can also form a blood clot which prevents blood supply to the heart. Coronary artery spasm (CAS), discussed above is yet another cause of MINOCA.
Even leadings doctors and experienced physicians miss the presence of MINOCA and send patients back home assuring them of good health. The diagnosis is often overlooked or the patients are either undertreated or overtreated. While doctors should take double care while treating these patients, patients should also consider themselves to be at risk for a repeated heart attack and take precautionary measures. Leading a healthy lifestyle, staying active, doing exercise, eating a healthy diet and keeping cholesterol, blood pressure and diabetes levels in check play a great role in preventing a heart attack. Get in touch with a nutritionist/dietitian at www.firsteatright.com who can help you chalk out a healthy diet plan satisfying your nutrition needs.
What remains surprising is the absence of any strong reason showing the higher frequency of MINOCA in female patients comparatively. Hope to find a satisfying answer in the near-future with some great research done!
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Dietitian & Nutritionist Dr. Nafeesa Imteyaz.