The Dan­ger Of ‘Silent’ Heart At­tacks

About half of all heart at­tacks are mis­taken for less se­ri­ous prob­lems and can in­crease your risk of dy­ing from coro­nary artery dis­ease.

Health & Nutrition - - CONTENTS -

Know all about SMI

You can have a heart at­tack and not even know it. A silent heart at­tack, known as silent my­ocar­dial in­farc­tion (SMI), ac­counts for 45% of heart at­tacks and strikes men more than women. They are de­scribed as ‘silent’ be­cause when they oc­cur, their symp­toms lack the in­ten­sity of a clas­sic heart at­tack, such as ex­treme chest pain and pres­sure; stab­bing pain in the arm, neck, or jaw; sud­den short­ness of breath; sweat­ing, and dizzi­ness.

“SMI symp­toms can feel so mild, and be so brief, they of­ten get con­fused for reg­u­lar dis­com­fort or an­other less se­ri­ous prob­lem, and thus men ig­nore them,” says Dr Jorge Plutzky, di­rec­tor of the vas­cu­lar dis­ease pre­ven­tion pro­gramme at Har­vard-af­fil­i­ated Brigham and Women’s Hospi­tal. For in­stance, men may feel fa­tigue or phys­i­cal dis­com­fort and chalk it up to over­work, poor sleep, or some gen­eral age-re­lated ache or pain. Other typ­i­cal symp­toms like mild pain in the throat or chest can be con­fused with gas­tric re­flux, in­di­ges­tion and heart­burn. Also, the lo­ca­tion of pain is some­times mis­un­der­stood. With SMI, you may feel dis­com­fort in the cen­tre of the chest and not a sharp pain on the left side of the chest, which many peo­ple as­so­ciate with a heart at­tack. “Peo­ple can even feel com­pletely nor­mal dur­ing an SMI and af­ter­ward, too, which fur­ther adds to the chance of missing the warming signs,” says Dr Plutzky.

Un­aware of pos­si­ble dan­ger

The num­ber of peo­ple who suf­fer an SMI and don’t re­al­ize it is alarm­ing. A study in the ‘Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion’ looked at al­most 2,000 peo­ple ages 45 to 84 (half of whom were men) who were free of car­dio­vas­cu­lar dis­ease. Af­ter 10 years, 8% had my­ocar­dial scars, which are ev­i­dence of a heart at­tack. Most sur­pris­ing was that 80% of th­ese peo­ple were un­aware of their con­di­tion. Over all, the preva­lence of my­ocar­dial scars was five times higher in men than in women. SMI and reg­u­lar heart at­tacks share the same risk fac­tors: Smok­ing, be­ing over­weight, lack of ex­er­cise, high blood pres­sure, high choles­terol lev­els, and di­a­betes. They can be just as dan­ger­ous, too. “SMI of­ten leaves scar­ring and damage to the heart, which, com­bined with the fact that

Once an SMI is di­ag­nosed, your doc­tor can iden­tify your main risk fac­tors and help de­sign a treat­ment strat­egy, such as chang­ing your diet, ex­er­cis­ing reg­u­larly, or tak­ing statins, if needed.

many peo­ple who have an SMI don’t seek im­me­di­ate care, can fur­ther raise a per­son’s risk of a sec­ond and po­ten­tially more harm­ful heart at­tack,” says Dr Plutzky. In fact, peo­ple who have an SMI and don’t get treat­ment have a three times greater risk of dy­ing from coro­nary artery dis­ease. “A silent heart at­tack is a loud sig­nal your body sends that you have some kind of un­der­ly­ing health issue that needs at­ten­tion,” says Dr Plutzky.

How to get checked out

Men may not be aware they had an SMI un­til weeks or even months later when they see their doc­tor for a reg­u­lar visit, or be­cause of per­sis­tent symp­toms like fa­tigue, short­ness of breath, or heart­burn. SMI is usu­ally de­tected from an elec­tro­car­dio­gram (EKG) or echocar­dio­gram, which can high­light heart mus­cle damage. An­other method is a blood test for the molec­u­lar foot­prints of tro­ponin T, a pro­tein re­leased by in­jured heart cells. That test is of­ten used in emer­gency de­part­ments for pa­tients with heart at­tack symp­toms. Once an SMI is di­ag­nosed, your doc­tor can iden­tify your main risk fac­tors and help de­sign a treat­ment strat­egy, such as chang­ing your diet, ex­er­cis­ing reg­u­larly, or tak­ing statins, if needed, as well as other med­i­ca­tion to help pre­vent a sec­ond heart at­tack (see box). “If you do no­tice any symp­toms of a SMI, do not brush them aside, even if you do not think they are se­ri­ous,” says Dr Plutzky. “Play­ing it safe is al­ways a bet­ter move than risk­ing the po­ten­tial harm­ful down­side.”

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