Doctor Q&A: What we can learn about heart attacks from ‘This is Us’

In a recent episode of the NBC show ‘This is Us’, viewers finally learned the cause of beloved character Jack Pearson’s death.

Jack is delivered by ambulance to an area hospital to be treated for minor burns on the heels of a devastating house fire. The episode takes an unexpected turn when Jack — seemingly fine apart from a few burns — dies.

Doctors cite smoke inhalation as the cause for cardiac arrest. Later in the episode the cause of Jack’s death is referred to a “widowmaker” heart attack.

While ‘This is Us’ viewers are still recovering from broken hearts, we talked to Ahmad Slim, MD, from Pulse Heart Institute to learn more about what a widowmaker heart attack is.

What is a widowmaker heart attack? 

It is an old term used to describe a heart attack involving one of the major blood vessels called the left anterior descending (LAD) vessel, that feeds a large portion of the heart muscle. In the past, a total occlusion of this blood vessel was almost always associated with near 100 percent mortality from cardiac arrest due to limited available treatment options.

The large muscle mass of the heart was deprived of oxygen, stopped beating normally and degenerated into a fatal rhythm called ventricular fibrillation that led the heart to stop beating.

How common is this type of heart attack? 

It is fairly common. The reason we do not hear about widowmaker heart attacks as often today is that now they are usually identified early on the scene by paramedics and medical therapy is initiated immediately. Today, the time between transport to the hospital to when the blood vessel is opened by percutaneous intervention is less than 90 minutes. In most cases it happens in under 60 minutes.

What are the signs of a widowmaker heart attack?

They are no different than any other heart attack, it is the location within the heart that differs, as well as how much of the heart muscle is involved. Most, but not all, patients commonly will have chest discomfort that can radiate to jaw and arms, with some association with sweaty, clammy feeling and sometimes shortness of breath and nausea.

Can smoke inhalation cause cardiac arrest?

Yes. Smoke inhalation can damage the lungs and increase toxins in the blood stream and decrease circulating oxygen to the extent that prolonged exposure alone can lead the heart to stop. However, in relation to this particular heart attack, it is the strain on the heart from lack of oxygen and increased workload combined with an increased adrenaline level that leads a blockage within the blood vessel to break, exposing its contents to the blood stream and forming a clot that completely blocks blood flow to the heart muscle, and leading to death.

Do people recover from a widowmaker heart attack?

When the term was used in the past, prior to the advent of revascularization treatment, mortality rates with heart attacks was very high. Currently, with new technologies and immediate revascularization treatment, the complication rates and death from heart attacks are less than 10 percent. In addition, patients are knowledgeable about the signs and symptoms of heart attack and our EMT personnel are well trained in treating patients in the field until they get to the definitive treatment center.

In the episode, Jack dies in a matter of minutes. What happens when someone goes into cardiac arrest in a hospital setting? How do care teams treat heart attacks?

Most patients in a hospital setting who have a heart attack survive the heart attack without progressing to cardiac arrest as the signs, symptoms and monitoring detects heart attacks well before they reach that point. However, if a patient presents with cardiac arrest and associated cardiogenic shock — a condition in which your heart suddenly can’t pump enough blood to meet your body’s needs — the heart muscle usually is deprived of oxygen for a long enough period of time (unless CPR and ACLS is done in the field with return of circulation) that the mortality rate remains high at 50 percent despite any aggressive measures.

Did you know February is American Heart Month? Learn more about heart health and cardiovascular care at Pulse Heart Institute.