Silent heart attacks:

abstract human heart isolated on black background

On television, heart attacks are portrayed in rather dramatic fashion — typically, an older man clutching his chest with agonizing pain. This mental image is embedded in our culture, but it actually represents only a small fraction of heart attacks. As it turns out, a variety of different symptoms may develop with a heart attack. In addition to chest pain, some of the other symptoms that can occur with a heart attack include chest pressure, chest heaviness, arm pain, neck pain, jaw pain, shortness of breath, sweating, extreme fatigue, dizziness, and nausea. That is, in part, why it is not always so easy to diagnose a heart attack. And of course, women are also at risk for heart attacks. Whether women are more likely than men to have these symptoms other than chest pain remains a controversial point.

Now, research from the Atherosclerosis Risk in Communities (ARIC) Study has found that almost half (45%) of heart attacks appear to be clinically silent — that is, not associated with any symptoms at all, at least that the patient can recall. These sorts of silent heart attacks were picked up by use of a routine electrocardiogram (ECG). And these silent heart attacks weren’t just a meaningless abnormality picked up on a test. The silent heart attacks were associated with a similar risk of subsequent death as clinically detected heart attacks.

Older studies had more or less come up with similar findings. The present study extended these observations into a much more diverse population. The excess risk associated with silent heart attacks was found to be present in both men and women. Of note, rates of both types of heart attack were higher in men than in women. There was also an excess risk of future death associated with both clinical heart attacks and silent heart attacks in both white and African American patients. Other races were not examined in this study, and more work needs to be done in this regard, though likely the results would be similar.

What does this mean for people who are worried about heart attacks? Guidelines for physicians from professional medical societies in general no longer recommend routine ECGs in healthy people, though this used to be a common practice. Certainly, if you should have an ECG for some purpose, such as before certain types of surgery, and a silent heart attack is detected, that needs to be taken seriously — really, as though you had had a clinically apparent heart attack. Any medications and lifestyle changes prescribed as a result of detecting a silent heart attack should also be relatively similar.

Future studies will have to determine if certain populations might benefit from routine screening for silent heart attacks. Beyond any studies done within the world of conventional medical research, the increasing availability of various apps will allow people to get ECGs on themselves, so detection of silent heart attacks will probably increase. The risk of this sort of indiscriminate screening is that one test abnormality might lead to another set of more expensive and risky tests. So, hopefully we can sort our relatively quickly (i.e., in the next few years) who might be best served with routine screening with ECGs, or perhaps even more sophisticated tests to detect silent heart attacks or people at risk for them.

Related Information: Harvard Heart Letter

abstract human heart isolated on black background

Below are spiritual recipe for health and wellness: Matthew E. McLaren

I delight greatly in the Lord; my soul rejoices in my God. For he has clothed me bridegroom adorns his head like a priest, and as a bride adorns herself with her jewels. Isaiah 61:10 NIV

Until now you have not asked for anything in my name. Ask and you will receive, and your joy will be complete. John 16:24 NIV

Each of you should give what you have decided in your heart to give, not reluctantly or under compulsion, for God loves a cheerful giver. 2 Corinthians 9:7 NIV

A person finds joy in giving an apt reply— and how good is a timely word! Proverbs 15:23 NIV

That is why, for Christ’s sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties. For when I am weak, then I am strong. 2 Corinthians 12:10 NIV

Rejoice with those who rejoice; mourn with those who mourn. Romans 12:15 NIV

You are my hiding place; you will protect me from trouble and surround me with songs of deliverance.

Psalm 32:7 NIV

So that I may come to you with joy, by God’s will, and in your company be refreshed. Romans 15:32 NIV

Your statutes are my heritage forever; they are the joy of my heart. Psalm 119:111 NIV

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