Sneak Attack – Silent Heart Attacks
You can have a heart attack and not even know it! Silent heart attacks or silent myocardial ischemia occur when oxygen carrying blood flow to the heart muscle is reduced without symptoms of chest pain, nausea, shortness of breath, neck/jaw/arm pain, etc. or with symptoms so mild as to not be recognized as a serious event. However, these events can be detected by various tests including EKG, or stress echocardiogram for example. Those suffering with diabetes (especially when associated with high cholesterol), hypertension, chronic kidney disease and sleep apnea are at higher risk for silent heart attacks. Other risk factors are familiar such as age, smoking and obesity. Men have a higher incidence than women. Those with silent myocardial infarctions are also at increased risk of death from not only coronary heart disease but from any cause. Perhaps surprisingly, silent heart attacks can account for as much as 45% of all heart attacks. Again, these events occur with no or minimal symptoms and can be brief. However, these events can cause injury to the heart muscle resulting in scarring and decreased function. In addition, they raise the risk of subsequent more serious events.
Who Should Be Screened and When?
In general, individuals who do not have associated risk factors such as smoking, obesity, diabetes, hypertension, etc. do not require specific screening for silent myocardial ischemia. For those who do carry risk factors noted above or a strong family history, talk with your physician at Rockwell Physicians regarding your risk for coronary artery disease. Strategies for assessing and clarifying risk can include 10-year risk assessment, EKG, coronary artery calcium scoring (via a low energy CT scan), or exercise stress test.
When Symptoms Are Not Silent
While Silent Myocardial Symptoms Are Subtle Or Even Absent. Symptoms That Require Immediate Medical Evaluation Include: An Uncomfortable Sensation In The Chest That Lasts Several Minutes Or May Even Come And Go Over Several Hours. The Discomfort Can Often Be Described As Pressure, Squeezing, Deep Ache Or Burning. Similar Discomfort In One Or Both Arms, Upper Back, Neck, Jaw, Or The Stomach. Other Symptoms Can Include Shortness Of Breath, Sweating, Nausea Or Feeling Faint.
Gul Z, Makaryus AN. Silent Myocardial Ischemia. [Updated 2020 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536915/ Race and Sex Differences in the Incidence and Prognostic Significance of Silent Myocardial Infarction in the Atherosclerosis Risk in Communities (ARIC) Study. Zhu-Ming Zhang, Pentti M. Rautaharju, Ronald J. Prineas, Carlos J. Rodriguez, Laura Loehr, Wayne D. Rosamond, Dalane Kitzman, David Couper, and Elsayed Z. Soliman Originally published 16 May 2016 | https://doi.org/10.1161/CIRCULATIONAHA.115.021177Circulation. 2016;133:2141–2148 Silent myocardial ischemia: Epidemiology, diagnosis, treatment, and prognosis Author:Prakash C Deedwania, MDSection Editor:Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHADeputy Editor:Todd F Dardas, MD, MS. All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through Apr 2021. | This topic last updated: Sep 16, 2019. Cardiovascular disease risk assessment for primary prevention in adults: Our approach Author:Peter WF Wilson, MDSection Editor:Bernard J Gersh, MB, ChB, DPhil, FRCP, MACCDeputy Editors:Susan B Yeon, MD, JD, FACCJane Givens, MD. All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through Apr 2021. | This topic last updated: May 29, 2020. Screening for coronary heart disease Authors:Stephen L Kopecky, MD, FACC, FAHA, FACP, FASPCMeghana G Halkar, MBBSSection Editor:Patricia A Pellikka, MD, FACC, FAHA, FASEDeputy Editor:Jane Givens, MD. All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through Apr 2021. | This topic last updated: Sep 18, 2020.