World No Tobacco Day: Pakistani expat in UAE, 35, survives 'widowmaker' heart attack from social smoking

Abu Dhabi: At just 35, Waqas, a Pakistani expat in Abu Dhabi, believed he was in good health. With no comorbidities or obesity, his only bad habit was smoking socially once or twice a week.

One morning, after experiencing chest pain that had begun the previous day, Waqas decided to visit the Emergency Care Department at LLH Hospital, Musaffah. What seemed like a precaution quickly turned into a fight for survival as his pain worsened, prompting the medical team to intervene urgently.

According to Dr Jamuna Devi, Consultant Cardiology, LLH Hospital, Musaffah, the patient suffered from a Non-ST-Elevation Myocardial Infarction (NSTEMI), a dangerous type of heart attack. Unlike a full blockage, an NSTEMI is a heart attack caused by a partially blocked artery, where reduced blood flow still injures the heart muscle.

The cause was a near-total occlusion of the Left Anterior Descending (LAD) artery.

LAD is nicknamed the “widowmaker” because it supplies roughly 60% of the heart’s muscle with oxygen-rich blood. A major blockage can trigger a severe and potentially fatal heart attack.

Without immediate intervention, a massive portion of Waqas’s heart muscle was at risk of permanently dying, which could have led to acute heart failure or fatal heart rhythm disturbances (arrhythmias).

Immediate intervention saves life

Dr Jamuna and her medical team rushed him into an emergency coronary angiogram, followed by emergency angioplasty and stenting (PCI-Percutaneous Coronary Intervention) of the LAD artery. The blocked vessel was mechanically opened, and a stent was placed to keep it open.

“He responded excellently. Normal blood flow was immediately restored to the heart muscle, limiting permanent damage and relieving the underlying ischemia that caused the heart attack,” says Dr Jamuna.

In Waqas’s case, the only major risk factor was occasional smoking, proving that young age and a healthy body weight do not guarantee immunity to cardiovascular diseases.

“In a young person without extensive, long-term cholesterol buildup, a heart attack is frequently caused by a sudden rupture of a small, unstable plaque or a severe spasm of the blood vessel, leading to an acute blood clot. Smoking even a few cigarettes a week is more than enough to irritate the lining of the blood vessels, making the blood prone to clotting and causing the artery to violently constrict,” explains the doctor.

Waqas says he was shocked to learn about this as he never thought occasional smoking would lead to something dangerous like this. “I immediately decided to quit smoking. I have learned that tobacco or nicotine, in any form or amount, is unsafe and can be deadly. I hope my case helps people understand the danger of even smoking once or twice a week.”

Smoking is harmful in every way

Many young people believe that occasional or social smoking is harmless. However, Dr Jamuna cautions that smoking just 1 to 4 cigarettes a day, or even smoking occasionally on weekends, triggers nearly 70% of the cardiovascular risk of a heavy smoker.

“While lung cancer risk scales closely with the volume of smoke over decades, heart attacks are triggered by acute shifts in blood clotting and vessel inflammation, which require very little exposure,” she warned.

Each puff of cigarette smoke triggers a chain reaction in the heart’s blood vessels, damaging their delicate lining, forcing them to spasm under a surge of adrenaline, and making the blood dangerously sticky and prone to clotting.

“In this case, occasional smoking caused a sudden spasm or a minor plaque tear over a sticky pool of blood, forming an instant clot that caused his heart attack.”

The doctor’s warning comes on World No Tobacco Day, observed annually on May 31 to raise awareness about the dangers of tobacco use, advocate for effective policies to reduce consumption, and expose the deceptive marketing tactics of the tobacco and nicotine industries.

The theme of this year's World Health Organisation (WHO) campaign is "Unmasking the appeal: Countering nicotine and tobacco addiction."

Ways to prevent global challenge

Cardiologists worldwide are seeing more heart attacks among people in their twenties and thirties. Tobacco, whether cigarettes, e-cigarettes, vapes, or flavoured hookah, plays a massive role. Combined with stress, poor sleep, sedentary lifestyles, and substance abuse, the risks are multiplying.

“There is no safe limit for tobacco use. Your heart and blood vessels do not know the difference between social smoking and daily habits. They get affected,” said Dr Jamuna.

“A single cigarette can also cause temporary acute arterial stiffness and blood clotting that lasts for hours. Even passive smoke contains the exact same toxic compounds that firsthand smokers inhale. Prolonged exposure increases the risk of a heart attack by an estimated 25% to 30%,” she explained.

The key is to stay tobacco-free, she pointed out. “Even if you look fit, make regular checkups a habit since genetic risks can hide behind a normal BMI. Aim for at least 150 minutes of moderate aerobic exercise weekly, and follow an anti-inflammatory diet rich in antioxidants, omega-3 fatty acids, vegetables, and whole grains while minimising ultra-processed foods,” the doctor advised.