The whispering heart - Silent heart attack

    What you should know about a silent heart attack and its deadly assault on your body
    We know the obvious signs of a heart attack: chest pain, shortness of breath, a cold sweat. But what if you’re going through one without the symptoms, when you’re out shopping, or in the gym, or even at a friend’s? Cardiologists tell us more.

    It has a name
    “A heart attack does not always have obvious symptoms. It can happen without a person knowing it. Known as a silent heart attack or medically referred to as Silent Myocardial Infraction (SMI), it is like any other heart attack where blood flow to a section of the heart is temporarily blocked and can cause scarring and damage to the heart muscle,” says Dr Niraj Gupta, Director Cardiology Center, Medanta Africare, Nairobi Kenya.

    It is more common than we realise
    The World Health Organization talks of asymptomatic (with no symptoms) ischemia (inadequate blood supply to an organ, in this case the heart). This occurs in approximately 25% to 50% of patients with coronary artery disease (CAD). It may outnumber symptomatic episodes by a ratio of more than 20:1.

    They are dangerous for more than one reason
    Since you don’t get treatment as soon as you should, blood flow to the heart might not be restored quite as quickly as actually feeling the symptoms and getting help. The impact on the future is greater. “Compared to other countries, in Kenya, heart attack occurs at a much younger age. Once you have had a silent heart attack you may not take proper treatment to prevent further attacks, nor will you be jolted into a healthy lifestyle. All these make you more vulnerable to a more dangerous heart attack in future,” says Dr Niraj Gupta, Director Cardiology Center, Medanta Africare.

    Symptoms are subtle and don’t last long
    Those who suffer a silent heart attack may experience unexplained fatigue, common with women and the elderly. People may also experience symptoms of heart disease (rather than heart attack) and only later discover that they have suffered from one, sometimes weeks or months after it occurs. These are subtle, non-specific symptoms: indigestion or the feeling of a heavy weight being placed on the chest, a squeezing or wringing sensation, pain that extends to the neck, jaw, back, abdomen, arm, shoulder and that may be misconstrued as a strained muscle, digestion problems like nausea, vomiting or overall GI problems. SMI symptoms can be so mild, and so brief, they often get confused for regular discomfort or another less serious problem. “The pain is not always around the heart region. Even people who have had a heart attack may not recognise the signs, because this can have entirely different symptoms. Those with diabetes may not feel the pain,” says Dr Niraj Gupta, Director Cardiology Center, Medanta Africare. If you have at least two symptoms, check in with your doctor, he says.

    The risk factors are the same
    A sedentary lifestyle and diet, hypertension, being overweight, obese and inactive, diabetes, a family history of heart disease, tobacco use, are all responsible. “Apart from these risk factors, there are certain population groups that have been found to be at an increased risk of silent heart attack. Patients with known Coronary Artery Disease (CAD) have silent ischemic episodes four times as often as symptomatic episodes. Critically ill patients admitted to the Intensive Care Unit (ICU) for non-cardiac causes are at risk of this too. There is also a relatively high incidence of peri-operative (around the time of surgery) SMI in the geriatric population undergoing elective surgery,” says Dr Gupta. Those living with diabetes are at twice the risk compared to those who don’t have the disease. Obstructive sleep apnoea is also associated with an increased risk of silent heart attack.

    You must react
    If you notice the signs, contact your nearest hospital immediately. As soon as you get to the hospital, let them know of the symptoms. Tests like an electrocardiogram (ECG), echocardiogram and radionucleotide imaging studies among others help diagnose whether or not a person has suffered from a silent heart attack. If an SMI is diagnosed, your cardiologist can identify the risk factors and help design treatment strategy to help prevent a second heart attack.

    We can prevent it
    Keep the risk factors at bay, and look to a healthy lifestyle. Exercise, eat a diet predominantly of vegetables and fruits, avoid smoking, cut stress and keep drinking to a minimum. Above all, listen to your body and when you sense that something’s amiss, there’s no harm getting it checkout out. “Timely intervention in the form of prevention or timely treatment is paramount to saving lives,” says Dr. Niraj Gupta.