- Doctors often assume heart attacks in younger people arise from blocked arteries.
- However, a new study suggests that these heart attacks often have other causes.
- The researchers noted that this was especially true for younger women.
- This is important since different treatments are needed for these heart attacks.
When doctors think about heart attacks in younger people, they typically assume the cause is the same as in older patients: blocked arteries from cholesterol buildup.
However, a groundbreaking 15-year study of nearly 3,000 people ages 65 and under suggests this assumption may be dangerously wrong, particularly for women.
This discovery could revolutionize how emergency rooms diagnose and treat heart attacks in younger patients, potentially saving lives by ensuring that these individuals receive the correct treatment for their condition.
The study, called OCTOPUS (Olmsted Cardiac Troponin in Persons Under Sixty-six), took a comprehensive approach to understanding heart attacks in younger people.
Between 2003 and 2018, researchers tracked every person ages 65 and under in Olmsted County, Minnesota, who had elevated levels of troponin — a protein released when heart muscle is damaged.
This method was crucial because it captured heart attacks that might otherwise be missed.
Many previous studies only included patients who arrived at hospitals with classic chest pain and obvious heart attack symptoms on their electrocardiograms.
By casting a wider net, the Mayo Clinic team found 4,116 troponin-positive events in 2,790 people.
Two cardiologists then meticulously reviewed each case, examining medical records, heart imaging, and coronary angiograms — the X-ray movies that show blood flow through heart arteries.
When they disagreed on a diagnosis, they brought in additional experts to reach a consensus.
This detective work was essential because many non-traditional heart attack causes can look identical to classic blockages on initial examination.
The researchers classified each heart attack into six distinct categories based on what actually caused the heart muscle damage: traditional artery blockages (atherothrombosis), spontaneous coronary artery dissection (SCAD), blood clots from elsewhere in the body (embolism), artery spasms, supply-demand mismatches, and truly unexplained cases.
The results revealed dramatic gender differences that could reshape emergency medicine.
While 75% of heart attacks in younger males were caused by traditional artery blockages, only 47% of heart attacks in females had this cause.
The remaining 53% of heart attacks in females came from other mechanisms.
Spontaneous coronary artery dissection — where an artery wall spontaneously tears — was particularly common in women, causing 11% of their heart attacks compared to less than 1% in men.
The condition was so frequently missed that 55% of SCAD cases were initially misdiagnosed as either traditional blockages or unexplained heart attacks.
Misdiagnosis is a problem, according to the researchers, because treating SCAD like a traditional heart attack can actually make things worse.
Procedures like angioplasty, which help unblock arteries, can be dangerous when performed on torn artery walls.
Females also had much lower overall heart attack rates — 48 per 100,000 person-years compared to 137 per 100,000 in males.
For traditional artery blockages specifically, the difference was even starker: 23 per 100,000 females versus 105 per 100,000 males.
Interestingly, when females did have traditional heart attacks, they were just as sick as males, with similar amounts of artery disease visible on angiograms.
However, females had higher rates of diabetes and high blood pressure, suggesting they may need more risk factors than men to develop the same degree of heart disease.
The study also found that secondary heart attacks — those triggered by other medical emergencies like severe anemia or dangerously low blood pressure — carried the highest death rates over five years, at 33%.
In contrast, SCAD patients had no deaths during the study period.
These findings suggest that emergency departments and cardiologists need new approaches for evaluating younger patients with possible heart attacks, particularly women, who may require different diagnostic tests and treatments than the standard protocols designed primarily around older male patients with traditional artery blockages.
Bradley Serwer, MD, an interventional cardiologist and chief medical officer at VitalSolution, said it is crucial to understand that not all heart attacks are identical or caused by the same events.
“Being young, healthy, and female does not guarantee immunity from heart attack,” he stressed.
Keeping this in mind, Serwer said it’s vital to listen to your body.
“If you experience new onset chest pain, shortness of breath, or severe exertional fatigue, seek medical attention immediately,” he advised.
“Do not ignore the symptoms because you may be considered low risk for a heart attack.”
When it comes to chest pain, Serwer explained that there are several key characteristics that can tell you if your pain is related to your heart:
- Your jaw pain begins during moderate exercise and subsides with rest.
- The pain is mainly on the left side of the jaw, especially when there is no redness or swelling in the jaw.
- The pain is also felt in the neck and arm.
- There is shortness of breath, sweating, or clammy skin.
- You have other cardiac risk factors, such as smoking, diabetes, high blood pressure, high cholesterol, or a family history of coronary artery disease.
Finally, Serwer noted that women do not always exhibit the classic heart attack symptom of chest pain.
“Instead, they may experience shortness of breath, nausea, indigestion, or upper abdominal pain, dizziness or passing out,” he explained.
“If you experience any of these symptoms, it is imperative to seek prompt evaluation either in the Emergency Room or by your primary care physician,” said Serwer.
Michael Doney, MD, executive medical director at Biograph, explained that women and men of all ages, but especially those who are younger, should use clear, concise language when describing their symptoms to healthcare providers.
For example, you could say: “I’m experiencing aching pain in my neck and jaw, and I feel sick to my stomach and dizzy. These symptoms came on suddenly, and I have never experienced anything like this before. I have a history of autoimmune disease, and I’m concerned I’m having a heart attack.”
“Being direct helps your doctor focus on your specific symptoms and concerns, making sure they don’t mistake your symptoms for something less serious without checking for cardiovascular disease risks,” he said.
Doney also said it’s essential to understand your options and know what tests are needed to evaluate your condition, and to make it clear that you wish to have these tests performed.
“For example, an electrocardiogram (ECG), which records a tracing of the heart’s electrical activity, rate, and rhythm, is an important screening tool and is often used in conjunction with certain blood tests to assess injury to the heart muscle,” he said.
Lastly, Doney said if your doctor is resistant to your concerns, you should not hesitate to ask for a second opinion. Or bring a trusted family member or friend with you to provide support and advocacy, if needed.
