Silent heart attacks: What you need to know
February 25, 2000
Web posted at: 4:27 PM EST (2127 GMT)
By Sharon Cohen
(WebMD) -- You'd certainly know if
you were having a heart attack, wouldn't you? After all, you
couldn't possibly miss symptoms as unmistakable as crushing chest
pain or extreme shortness of breath. Or could you?
More than one in five people over
the age of 65 who have heart attacks have unrecognized ones,
according to a study published in the January issue of the Journal
of the American College of Cardiology. Researchers evaluated
nearly 6,000 men and women aged 65 and older. Of the 901 subjects
in whom an electrocardiogram -- a test to record the electrical
current that runs through the heart muscle -- indicated a prior
heart attack, more than one fifth had had heart attacks that had
gone undetected until the test was done. Most patients had no
clear indications of cardiovascular disease when they started the
study.
These so-called silent heart
attacks are of two types, says Dr. P. K. Shah, director of
cardiology at Cedars-Sinai Medical Center in Los Angeles.
"One kind is truly silent -- it has no symptoms. The other
has symptoms, but they are either very mild or are ignored because
they are usually not associated with heart attacks, such as
sweating or indigestion," he says.
Because these silent heart attacks
go undetected, they can't be treated. This increases the chance of
underlying heart disease becoming more advanced and causing
another, more serious heart attack. But with simple awareness, you
can do much to reduce the risk of overlooking a silent attack.
Taken by surprise
Fourteen years ago, 80-year-old
Joseph Smith (not his real name) suffered an episode of vertigo
that caused him to go to the emergency room. An electrocardiogram
revealed that he had, at some point in the past, suffered a silent
heart attack that his doctor described as "significant."
"Looking back, I couldn't
think of any signs or symptoms that I'd missed, and I was
disturbed to learn that I'd had a heart attack and not known
it," Smith says.
Eight years later, Smith
experienced mild chest pains but waited three months before seeing
a doctor. When he did get medical help, a stress test and an
angiogram revealed blocked coronary arteries, and he had to have
quintuple bypass surgery. Today, he's relatively healthy,
considering his history.
What's known, what's not
Smith's case isn't unusual. Though
exact numbers aren't known, many younger people also experience
unrecognized heart attacks.
"Unfortunately, there's no way
to predict who's likely to have them," says Dr. Stuart
Sheifer, a fellow in cardiology at Georgetown University Medical
Center in Washington, D.C., and the lead author of the study
published in the cardiology journal.
In terms of heart damage, these
unrecognized attacks aren't necessarily less severe than obvious
ones. "The first and only symptom of a silent heart attack
could be sudden death," Sheifer says. After six years of
follow-up in the study, his team of researchers found that death
rates from silent heart attacks were the same as those from
non-silent heart attacks.
Vigilance pays
To reduce the chance of a heart
attack passing unnoticed, you can become more aware of some
unexpected symptoms that accompany such an event.
"Most 'silent' heart attacks
really aren't silent; they're just not noticed," says Dr.
Richard Stein, chief of cardiology at the Brooklyn Hospital Center
in New York. "If questioned carefully, many patients will
recall some vague symptoms, such as indigestion or back pain, that
they blamed on something else at the time."
Be especially vigilant of symptoms
if you have heart-disease risk factors, such as a family history
of heart attack or other heart disease, obesity, inactivity,
smoking, diabetes, high blood pressure or high cholesterol. If you
have risk factors, you should also talk to your doctor about
getting frequent electrocardiograms, Sheifer says. If an old heart
attack is detected, it is wise to undergo a thorough treadmill
test or other kind of screening.
The voice of experience
Smith says his experiences have
made him more health conscious.
"I learned how to exercise and
watch my diet, and not to delay seeking medical help if I had any
symptoms at all," he says.
Doctors urge others to follow suit.
"If you have any doubts," says Stein, "go to the
emergency room. Don't worry about embarrassment -- it's better to
be embarrassed than dead."
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