The Widow-Maker Scare

Hidden risk factors, and how a routine stress test saved a life.
Cardiology patient Buddy Singh rides exercise bike at home

In the summer of 2023, Buddy Singh’s daily workouts were accompanied by an unexpected visitor: a mysterious pain in his back, nestled somewhere deep between his shoulder blades.

“I would only notice it when I was pushing myself the max on the stationary bike,” says Singh, an avid snowboarder and fitness enthusiast. “I figured it was a muscular issue that could be resolved with some physical therapy.”

However, Singh soon noticed the pain popping up during less rigorous exercise, too. Then one night, the pain awoke him from his sleep, leaving him rattled enough to visit the emergency department at The University of Vermont Medical Center the following day. There physicians performed an electrocardiogram (EKG) of his heart, a medical test that evaluates the heart’s electrical signals and can be used to identify potential problems with its health and function. The results of the EKG showed some irregularities, so they referred him for a cardiac stress test with the cardiology team about two weeks later.

“To be honest, I wasn’t too worried,” says Singh. “I’m a relatively young guy, I was in strong shape and overall living a healthy lifestyle. My cholesterol levels were occasionally elevated, but for the most part, I felt like I was doing all the things I was supposed to do to keep me and my heart healthy.”

He was right, but the stress test did not go as planned.

Escaping a Widow-Maker

As a cardiologist with The University of Vermont Health Network, Sherrie Khadanga, MD, evaluates cardiac stress tests dozens of times per day. Few result in immediate, emergency care. But on that day late in July, as Dr. Khadanga looked at the results of Singh’s stress test, she realized that something was seriously wrong.

“Outwardly, Buddy didn’t have a lot of the classic signs and symptoms of someone with a heart problem,” says Dr. Khadanga. “But under the surface, his heart was really straining, likely because of a blockage in one of his arteries. He needed additional care right away.”

At Dr. Khadanga’s urging, Singh went immediately to the emergency department at the UVM Medical Center, where he would receive an angiogram the following morning. The angiogram – an imaging procedure that uses a catheter to examine the coronary arteries – would show a 90% blockage in Singh’s left main artery, a major pipeline for supplying his heart with oxygen-rich blood. Known as a “widow-maker,” such blockages are often fatal if undiagnosed or left untreated.

“He could have had a massive heart attack at any moment,” says Dr. Khadanga.

To treat the blockage, interventional cardiologists installed a stent in Singh’s artery. A stent is a tiny mesh tube placed within the affected artery that improves blood flow and effectively resolves blockages, restoring healthy heart function. Singh went home the following day and was back on his bike later that same week, albeit a bit more cautiously than usual.

“It was a whirlwind few days, and it was only when things calmed down that I had a chance to think about what happened and how differently it could have played out,” reflects Singh.

A Hidden Risk Factor

One of the things left for Singh to contemplate was why this blockage occurred in the first place given his healthy lifestyle. “As a South Asian man, I knew I was at a slightly higher risk of heart issues, but I thought I was doing enough to offset that.”

Research has shown that South Asians – people who trace their ancestors to the Indian subcontinent – are at greater risk of developing cardiovascular diseases like the plaque buildup that blocked Singh’s coronary artery. Moreover, these diseases have also been found to be even more aggressive in South Asians living in the United States, presenting a significant health burden.

In hindsight, it was fortuitous that Dr. Khadanga was the cardiologist on call during Singh’s stress test. As a South Asian woman, Dr. Khandaga has long been interested in better understanding the unique cardiac risk factors facing South Asian communities, which too often go unacknowledged.

“Cardiovascular problems in South Asians are often underdiagnosed because, like Buddy, many people don’t fit the typical risk profile,” says Dr. Khadanga, whose grandfather died from a heart attack in his 50s. “It’s a huge blind spot, which is why it’s so important that we raise awareness about these risks in our community and get people thinking about their heart health earlier in life.”

As with most genetic predispositions, the risks to one’s heart can be mitigated by changing daily behaviors: altering your diet – like eating less salt and saturated fats – getting more exercise, being mindful of stress and cutting back on damaging habits like smoking or drinking alcohol, or eliminating them altogether. This is why cardiac rehabilitation, which is designed to help people gradually adapt their lifestyle to be more heart healthy, is so crucial to those diagnosed with heart disease or recovering from a heart procedure. Research has shown that completing a cardiac rehabilitation program can drastically reduce a person’s risk of having a second cardiac event like a heart attack, while also improving the quality and length of their life.

Six months on from his stent procedure, Singh says he feels better than ever. Back to exercising at his usual level – pain free – he acknowledges that while he only needed to make modest changes to his diet, it has nevertheless taken patience and persistence.

“I’ll be honest, I miss my snacks of extra-sharp cheddar cheese, but it’s all about moderation at this point,” says Singh with a laugh. “I consider myself really lucky. I never thought a little back pain would lead to a stent at my age, but hopefully my experience can help other people to think differently about their own personal risk factors.”

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