She had a heart attack at 35 but her arteries had no blockage: What’s this silent crisis affecting young people?

Why you can have a heart attack without a blockage

The explanation lay deeper, in the delicate inner lining of her blood vessels or the endothelium. When functioning well, it helps regulate blood flow smoothly in your arteries. But under the strain of chronic stress, poor sleep and anxiety, comorbidities like diabetes, hypertension and obesity, or smoking, this lining can become dysfunctional. The arteries may look clear, but they don’t behave normally. Blood doesn’t flow as efficiently as it should. The heart tissue, starved of adequate oxygenated blood, begins to suffer and over time is stressed enough to trigger a heart attack. Our executive had high stress and hypertension and smoked occasionally.

How to treat this kind of heart attack?

The woman patient didn’t need a stent. Instead, she was started on medications — aspirin to reduce clotting risk and statins to support vascular health. Usually, beta blockers, calcium channel blockers, ACE inhibitors, nitrates, antiplatelet agents are used to heal the damage and control inflammation. Gradually, her symptoms eased with routinising her life to restore work life balance, not compromising on meditation and exercise and keeping to hygiene, from food to sleep. She gave up smoking and even social drinking. Her recovery, in many ways, was smoother than that of patients with major blockages.

But the real treatment extended far beyond prescriptions. Because what her angiogram didn’t show was just as important as what it did. It didn’t show the accumulated toll of long work hours, chronic stress, poor sleep, all of which had likely shaped the condition she found herself in.

How to prevent such attacks

Doctors are increasingly seeing similar cases of heart attacks without the classic blocked arteries. Some are labelled under MINOCA, others under related conditions like ANOCA (Angina with Non-obstructive Coronary Arteries) where patients experience chest pain despite having less than 50 per cent blockages. What connects them is not obstruction but dysfunction.

If arteries can appear normal and still fail, what exactly are we missing? For years, heart disease has been associated with visible culprits like bad cholesterol, plaques, narrowed vessels, dramatic blockages. But conditions like hypertension, diabetes and smoking do more than just clog arteries. They alter how vessels function at a microscopic level. Add to that the less tangible but equally potent forces of stress and anxiety, and the picture becomes more complex. This case tells us about a silent damage that we easily dismiss.

The reassuring part is that patients like her often do well. Even when minor irregularities exist, outcomes are generally favourable with the right combination of medication and lifestyle changes. But the warning is harder to ignore: prevention is no longer just about avoiding blockages. It is about protecting how the body functions under pressure. The takeaway is, you don’t have to look like a heart patient to become one.

(Dr Shetty is lead cardiologist and medical director at Sparsh Hospital, Bengaluru)