Why did I have a heart attack despite no blockages?

Q: I had a heart attack (myocardial infarction) almost 6 years back but the angiography showed no blockages. What was the reason? I am 40 years old, weigh 100 kg and am 5 feet 11 inches tall.

A:The commonest problem for such a scenario is smoking. Heart attacks are due to clots that form inside heart blood tubes. These clots form on cracks in cholesterol plaques. Many times the plaque is so small that it is not seen on angiograms and the clot has dissolved by the time the angiogram is done. However, the damage to the heart muscle supplied by the blocked tube is done in 4 to 8 hours after the block. The good side is there is no angioplasty required. Other regions of the heart muscle will usually compensate for the lost tissue. This is warning that you should make appropriate life style changes and continue life long treatment with cholesterol lowering drugs and drugs that prevent blood clotting. A drug that prevents heart from dilating after a heart attack may also be needed life long. A fourth drug called a beta-blocker is usually given for 2 years after a heart attack.