Someone I know had a family member have a massive heart attack. They were saying how doctors said all four of his arteries were completely blocked.
From my understanding, when someone has all four heart arteries blocked, it takes time to get to that point. Meaning they couldn’t all have happened to clog at the same time. I could understand some gradual buildup in the arteries, but complete blockage in all four at the same time?? That just doesn’t sound right.
My question is wouldn’t they have had a heart attack when only one artery got blocked? Or can the heart continue to function when some arteries are blocked if there’s still one functioning? How were they even alive past the first blockage?
Maybe there was slight blood flow and partial blockage in the arteries so the heart was getting just enough flow to function until finally it got so blocked it couldn’t flow anymore. Do doctors just say the arteries were completely blocked as a general statement?
I’m just trying to understand how someone could even survive past a first single blockage. I’m sorry if it’s a stupid question, but I’m autistic so maybe I’m over analyzing a general statement that doctors might just say to people. I’m also going into nursing and I just am trying to understand because that statement just doesn’t make sense to me. I want to understand as completely as possible so I can be knowledgeable on it. Thank you 🙂
In: Biology
When they say “fully blocked” they mean “significant reduced flow requiring correction.” Your arteries can also expand and contract. So it can’t really be completely blocked so that there is no flow.
Its not a stupid question! This is an incredbily complex topic to ELI5 (also you asked many questions). I’ll try to be brief, but know, in doing so, I leave out 100 other possibilities.
>My question is wouldn’t they have had a heart attack when only one artery got blocked? Or can the heart continue to function when some arteries are blocked if there’s still one functioning? How were they even alive past the first blockage?
We have incredibly resiliant bodies with back ups built in. if one artery is clogged, another will try and supply its territory.
Some people can have a heart attack and the chest pain eventually subsides and so they just never get checked out. Then we find the dead areas of heart later after a bigger attack when they do finally get checked.
If the complete blockage happened at the very tip of the artery, which isnt as bad as a complete blockage of the beginning of the artery.
>Maybe there was slight blood flow and partial blockage in the arteries so the heart was getting just enough flow to function until finally it got so blocked it couldn’t flow anymore. Do doctors just say the arteries were completely blocked as a general statement?
Totally! Sometimes there could be a gradualy build up. Maybe all of them are at 50%, and slowly build up to 80 – 99%. Then slowly 1 by 1 they hit 100%.
Also, he could have had complete blockage of a few arteries and gotten those bypassed. Then more blockages develops (either of his native arteries, or of the bypasses themselves).
In any case, i hope your friend’s family member is doing okay now. And best of luck to you in your nursing endeavor!
Yes, the heart can continue to function when multiple vessels are blocked. Cardiologists don’t typically place a stent in a vessel until it is considered 70% occluded (or more). If the blockage is not recognized and it continues to worsen, it can eventually become what’s called a chronic total occlusion, or CTO. In the case of a CTO, it means that there is absolutely no flow beyond the blockage. In this case, sometimes the heart develops alternate flow to compensate for the lack of flow through the blocked vessel. These new vessels can be referred to as collaterals.
Heart attacks are not CTOs. A heart attack is an acute condition, though there can be existing CTOs as well that require intervention as well. In a heart attack, the vessel is blocked by a clot or a sudden-appearing piece of calcium/plaque. Because it happens suddenly, patients experience a variety of symptoms including chest pain, nausea, sweating, etc. whereas a CTO is a gradual blockage and sometimes symptomless.
If it is a clot causing the heart attack, it is removed with a vacuum device and the procedure is called a thrombectomy. A stent is placed in the site of the clot after it is removed. If it is plaque, it can be stented and reopened without any extra intervention or they can use a drill device to push through the plaque if there is any plaque that has hardened and made it difficult to place the stent. This is called atherectomy.
I find it hard to believe they had all arteries completely blocked, unless they meant two major vessels and their branches. For example, the left anterior descending artery has branches called diagonals, and the left circumflex artery has branches called obtuse marginals. These can have multiple blockages throughout and other vessels will compensate to maintain a functioning heart. If all the major arteries become blocked, the heart cannot continue to function.
Not a doctor, and I don’t know this person’s full situation, but I am a cath lab nurse and this is the knowledge I have to offer. Let me know if you have any questions!
You need to understand coronary arteries a little better, look those up first. There are two major coronaries, right and left and this is how the heart receives its blood supply, these main arteries branch off into other arteries like a tree branch. Without oxygenated blood going to the heart muscle, the area not being perfused (having blood flow) can die. As you follow the arteries down into the heart, that’s where the blockages occur. If one of those two main arteries are blocked off at the early part of them, you might not survive to surgery. People get more than 4 blocked off sometimes and need more than 4 bypass grafts- I’ve seen up to 7. Surgery isn’t the only option, you could get a stent placed which is like a Chinese finger trap that’s placed in the artery to open the blockage. Sometimes stenting is more preferable than open chest surgery- it may be all that’s needed OR the patient wouldn’t survive having their chest opened.
Having several blockages sometimes isn’t enough to kill someone. When an artery is blocked, it may not be fully blocked, the doctors can grade how blocked it is by percentage, so an artery can be 60% blocked for instance but it’s not enough to kill the heart muscle. Usually a bypass won’t be done if the artery is less than 50% blocked.
The ELI5 version:
Heart disease happens slow, then it happens fast.
The slow part: over time, deposits of cholesterol (and other stuff) build up in the walls of the arteries that feed the heart. We call these deposits “plaques”. People with large plaques can have difficulty getting enough blood to the heart, because the arteries are partially blocked. When they exert themselves, they need more blood to run the heart than they can get, so the heart doesn’t work well and it hurts. We call this pain “angina”.
The fast part: the plaques are buried in the wall of the artery. But sometimes they will break open, so that the inside of the plaque touches the blood as it goes by. When this happens, the blood clots in the artery and blocks it entirely (or nearly so). Then there is severe pain, and not enough blood getting through to run the heart even at rest. We call this a “heart attack” (technically: acute myocardial infarction). This is very painful, and if part of the heart does not get enough blood for enough time, that part of the heart will die.
>ELI5 How can someone have all four heart arteries completely clogged?
So, first they had the slow part, then the fast part. When this happens to the beginning of the arteries that feed the heart (the left main coronary artery), then all of the arteries become clogged. Often people die from this (this kind of heart blockage is called a “Widowmaker”). If a person gets to the hospital quickly, and is lucky, a doctor trained in this may be able to open up the blocked arteries.
I think “Completely clogged” is being used euphemistically here. Not a literal 100% blockage on all 4.
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