Si­lent heart at­tacks and the risks they pose

Daily Freeman (Kingston, NY) - - YOUR DAILY BREAK - Anthony Komaroff AskDr.K

I re­cently had an ECG in prepa­ra­tion for a sur­gi­cal pro­ce­dure. The doc­tor said it showed I’d had a si­lent heart at­tack. How could I have had a heart at­tack and not known about it?

I know it sounds strange. Af­ter all, on tele­vi­sion, heart at­tacks are por­trayed in rather dra­matic fash­ion. Typ­i­cally, you see a per­son clutch­ing their chest with ag­o­niz­ing pain. This men­tal im­age is em­bed­ded in our cul­ture. But my col­league, Dr. Deepak Bhatt, a car­di­ol­o­gist at Harvard-af­fil­i­ated Brigham and Women’s Hos­pi­tal, cites a re­cent study that is the lat­est to show that heart at­tacks of­ten can be “si­lent.”

Si­lent heart at­tacks are real. That is, the blood sup­ply to a part of the heart has been shut down, and a part of the heart mus­cle dies as a re­sult: That’s what a heart at­tack is.

How­ever, in si­lent heart at­tacks, peo­ple of­ten experience symp­toms other than se­vere chest pain. In­stead, they may have just a pressure or heavy feel­ing in the chest, or pain in the neck or jaw, or shoul­der and arm. Or they may have short­ness of breath, sweat­ing, ex­treme fa­tigue, dizzi­ness, or nau­sea. What­ever the symp­toms, they may not at­tribute them to a heart prob­lem. They may not even bring the symp­toms to the at­ten­tion of a doc­tor.

Or they may even have a heart at­tack that causes no symp­toms.

The re­cent re­port from the Ath­er­o­scle­ro­sis Risk in Com­mu­ni­ties (ARIC) Study was a large one: Nearly 10,000 healthy peo­ple were fol­lowed for nearly a decade, on aver­age. In nearly half (45 per­cent) of those who had a heart at­tack, the heart at­tack was “si­lent.”

If a heart at­tack didn’t cause any symp­toms, and now is over, does it mat­ter? For ex­am­ple, are you more likely to die from heart dis­ease in the fu­ture? The re­search team com­pared three groups:

1. Peo­ple hos­pi­tal­ized for heart at­tacks that caused symp­toms.

2. Peo­ple with si­lent heart at­tacks. 3. Peo­ple with­out heart at­tacks. Not sur­pris­ingly, the risk of death in the first group was nearly five times as high as in the third group. Sur­pris­ingly and un­for­tu­nately, the risk of death in the si­lent heart at­tack group was three times as high as in the third group.

Older stud­ies had more or less come up with sim­i­lar find­ings. The present study ex­tended these ob­ser­va­tions to a much more di­verse pop­u­la­tion. The ex­cess risk as­so­ci­ated with si­lent heart at­tacks was found to be present in both men and women. And it was found in both white and African-Amer­i­can pa­tients. Other races were not ex­am­ined in this study.

So hav­ing a si­lent heart at­tack is a se­ri­ous warn­ing sign. It may not be quite as se­ri­ous an omen as a heart at­tack that did cause symp­toms. But it’s a lot more se­ri­ous than never hav­ing had a heart at­tack. It means that it is much more im­por­tant for you to ob­serve a healthy life­style, and to treat any con­di­tions (like high blood pressure or high choles­terol) that put your heart at risk.

Dr. Komaroff is a physi­cian and pro­fes­sor at Harvard Med­i­cal School.)

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