As a doctor, I often hear people say things like, “I walk 3 km every day, eat healthy, and don’t smoke or drink, so I can’t have a heart attack.” It’s a common misconception that these lifestyle factors alone guarantee protection against heart disease. In fact, there are many different reasons why someone might have a heart attack, and it’s not always related to lifestyle choices.

One common question people ask is how it’s possible for someone who eats fast food every day and is severely overweight to avoid having a heart attack, while a seemingly healthy person still experiences one. The truth is, there are many factors at play when it comes to heart health.

One major cause of heart attacks is blockage of the arteries, which disrupts blood flow and can lead to a cardiac event. This can be caused by a combination of genetic factors and lifestyle choices like a high-cholesterol diet. Narrow arteries can increase the likelihood of blockages, and a diagnosis can be made using tools like an angiogram. Treatment options include stents or bypass surgery, and precautions like regular angiograms are recommended after age 50.

Another cause of heart attacks is blood clots that form and travel to the heart, which can happen by chance at any age. These clots can be detected using a D-dimer test and MRI, and treatment options include surgical removal or blood thinners like heparin.

Structural issues with the heart can also cause cardiac events, including weakness in the muscle wall, valve stiffness, and genetic predispositions. Diagnosis for these conditions can be made using an echo and treadmill test, and treatment options may include valve replacement surgery. Precautions like avoiding smoking and cocaine use are advised.

Infections can also lead to heart issues, such as myocarditis which occurs when the immune system attacks the heart during a major bacterial or viral infection. Diagnosis can be made using a heart CT and blood tests, and treatment options include antibiotics, steroids, and IV immunoglobulin.

Pulmonary embolisms can also lead to heart failure or strain due to clotting in the lungs, and fluid buildup in the heart can be caused by renal failure or damage. Tumors in the heart muscles or growths on the heart may also cause cardiac events.

It’s important to note that heart attacks and heart failures are both major cardiac events that can occur for a variety of reasons. Even the healthiest person can be at risk if they have genetic factors or other underlying conditions. Monitoring blood pressure, seeking medical attention for chest pain or high blood pressure, and getting regular screenings like ECGs, echos, and lipid profiles can help with early detection and prevention. Avoiding smoking and drugs is also important unless the heart is structurally strong.