Silent But Deadly
CNN recently reported on a study highlighting the prevalence of silent heart attacks. The term “silent” in this phrase generally means that the event is not accompanied by the typically recognizable symptoms of a heart attack, i.e. chest pain, shortness of breath, etc. It usually implies the discovery of a prior heart attack that the patient never knew anything about. According the research done by doctors at Duke University the prevalence of silent heart attacks is higher than previously suspected, as judged by the presence of minor damage detected on experimental MRI scans. One of the reasons these researchers were able to come to this conclusion is that the MRI is very sensitive to small amounts of damage and the heart can tolerate minimal insult without much in the way of symptoms (please see one of my previous posts about this subject).
We see this quite frequently in our practice. A patient comes in for routine evaluation by their primary doctor and is found to have an abnormal change to their electrocardiogram. They are then referred to us and we find that they developed a blockage in one of the coronary arteries at some point in the past. Patients are understandably surprised by this revelation and wonder how such a thing could happen.
Here’s my guess. My suspicion is that many of these are not truly “silent.” The symptoms of heart attack are so varied and, in certain individuals, so unusual that they are often attributed to something else. Remember that night when you ate too much Mexican food and sat up all night with indigestion? Or that day when you felt lousy and thought you may have had the flu? That could have been the moment the vessel closed off. The most common vessel to close “silently” is the right coronary artery (RCA). A heart attack involving the RCA is typically associated with more symptoms of dyspepsia (nausea, vomiting, discomfort in the upper abdomen) than other arteries.
In telling you about this I am honestly not trying to drum up business by planting the seeds of paranoia in everyone’s mind. I simply want to highlight the fact that coronary disease is common and can manifest itself in ways other than chest pain. If you have risk factors for coronary disease (high blood pressure, high cholesterol, family history of early disease, tobacco use, diabetes) and suffer symptoms that you remotely think might be cardiac in nature you need to get it checked out.
One of the interesting findings from the Duke research was that patients found to have silent heart attacks were much, much more likely to die prematurely. This is not due to the heart attack itself (it was silent, after all, and didn’t impair the patient’s life at the time) but rather to the lack of protective therapy that would go along with early recognition of coronary disease, such as statins, aspirin, and blood pressure medications.