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'This Is Us' Finally Revealed How Jack Pearson Died. Here's What a Doctor Says You Should Know About the Condition

From TIME - February 5, 2018

Spoiler alert: Last night on the hit TV show This Is Us, viewers finally learned how one of the main characters, Jack Pearson, dies.

After waking in the middle of the night to a fire in his home, the father of three helped his wife and children escape, rescued the family pet and managed to retrieve important family heirlooms from the burning building. But later, at the hospital, Jack went into cardiac arrest as a result of smoke inhalation. It was catastrophic, and Im afraid weve lost him, a doctor told Jacks wife, Rebecca.

When relaying Jacks death to his best friend Miguel, Rebecca later referred to it as a widowmakers heart attack. Online searches for the phrase spiked more than 5,000% in the hours after the episode that revealed Jacks death aired, and some viewers took to social media to tell their own stories about loved ones who had died fromor survivedsimilar incidents.

But what exactly is a widowmakers heart attack, and was the shows portrayal accurate? To find out, TIME spoke with Dr. Richard Katz, director of the George Washington University Heart and Vascular Institute. Heres what he says people should know about heart disease, sudden cardiac arrest and the causes of major heart attacks.

What is a widowmakers heart attack?

When doctors use the term widowmaker to refer to a heart attack, they usually arent talking about damage caused by smoke inhalation. Although its not a technical term, it usually implies a blockage of the left anterior descending (LAD) arterythe largest of the three arteries providing blood to the heart, also sometimes called the widowmaker artery.

The term is used because these types of blockages are very often fatal. A widowmaker heart attack occurs when that artery suddenly goes from 80% or 90% narrowed to 100% narrowed, says Katz. It happens very quickly, and suddenly youre depriving a large chunk of that heart muscle from oxygen.

This triggers a very fast, life-threatening heart rhythm called ventricular fibrillation, which causes people to collapse from sudden cardiac arrest. Sometimes this is transient and people wake back up, he says. But when the blockage occurs in the LAD, sadly this is when we see sudden cardiac death much more often.

Blockages in the LAD artery occur when plaque builds up over time. A poor diet and sedentary lifestyle are often big contributors, but widowmaker heart attacks can also occur in seemingly healthy people without warning. Genetics can also play a role.

Can smoke inhalation cause a widowmakers heart attack?

Its possible that a sudden stressful event can contribute to this type of heart attack, says Katz, if a person already has an underlying blockage. (On This Is Us, doctors explained to Rebecca that smoke from the fire put a tremendous amount of stress on Jacks lungs and his heart, which caused him to go into cardiac arrest. The character had no known history of cardiovascular problems.)

Smoke inhalation is going to decrease oxygen to the body, which would cause the heart to work harder, Katz says. If the heart is already struggling to get blood through a tiny pinhole, it could definitely degenerate into a life-threatening situation. The same thing could also happen during other stressful situations, like during strenuous exercise or while shoveling snow, he says.

What are the signs of a widowmaker heart attack?

Can people recover from a widowmaker heart attack?

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