The danger of a “silent” heart attack

Heart attacks don’t always cause the dramatic symptoms depicted on TV shows, which often show a middle-aged man clutching his chest in pain. Sometimes, the symptoms are far more subtle, such as unexplained fatigue and weakness, shortness of breath, or nausea (see “Is it a heart attack?”).

When that happens, people don’t always realize they’ve experienced a heart attack. But these so-called silent heart attacks may be almost as concerning as heart attacks that are recognized and diagnosed right away. Now, new research affirms that suspicion (see “Silent heart attacks may signal a higher risk of future stroke”).

“Doctors have long known that overt heart attacks are linked to a higher risk of stroke. This new study suggests that over the long term, unrecognized heart attacks may pose a similar risk,” says cardiologist Dr. Robert Giugliano, professor of medicine at Harvard Medical School.

Is it a heart attack?The most common sign of a heart attack is discomfort in the center of the chest that spreads through the upper body. But this classic symptom doesn’t always occur. Some people experience less typical symptoms, which may be slightly more frequent in women, people with diabetes, and older people.Typical symptomsPressure or a squeezing sensation in the middle of the chestChest pain or discomfort that spreads to the shoulders, neck, and armsSweatingLess typical symptomsTrouble breathingWeaknessNausea or vomitingDizzinessBack or jaw painUnexplained exhaustion

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Some of the heightened risk of stroke stems from shared risk factors, including high blood pressure, diabetes, and elevated cholesterol levels, all of which leave people more vulnerable to both heart attacks and strokes.

“But sometimes, a heart attack damages muscle in the wall of the heart,” says Dr. Giugliano. Damage in the heart’s lower chambers (ventricles) prevents the heart from contracting normally, which can lead to formation of a clot that then travels to the brain, causing a stroke.

Silent heart attacks may signal a higher risk of future strokeA study published online Aug. 3, 2021, by the journal Neurology looked at how heart attacks — including unrecognized “silent” ones — affected a person’s risk of stroke.Who: 4,224 older adults without a previous heart attack or stroke. All were part of the Cardio­vascular Health Study (CHS), which recruited people ages 65 and older from four counties in California, Maryland, North Carolina, and Pennsylvania.When: Participants were enrolled in the CHS in 1989 and 1990 and followed for a median of nearly nine years.How: Participants received annual electrocardiograms (ECGs) and twice-yearly phone calls, during which they were asked about any heart-related conditions or hospitalizations.Key findings: During the follow-up, 10% of the participants had a recognized (overt) heart attack, 9% had a silent heart attack, and 9% had a stroke. After adjusting for blood pressure, diabetes, and other confounding factors, researchers found that silent heart attacks were linked to a higher risk of stroke.

Diagnosis and treatment

People with diabetes are more likely to have silent heart attacks, perhaps because they’re prone to nerve-related problems that interfere with pain signals. But other people might attribute the discomfort of a heart attack to indigestion, a muscle strain, or an illness such as the flu.

Most unrecognized heart attacks are discovered on an electrocardiogram (ECG), a recording of the heart’s electrical activity. Heart muscle damage may create a distinct signature on an ECG. Because this test isn’t foolproof, other tests such as a heart ultrasound (echocardiogram) are often needed to confirm the diagnosis. For people with known heart disease, ECGs are routine. But for everyone else, the recommendations for additional testing are still evolving, says Dr. Giugliano. By age 65, you should have at least one ECG; other tests you may need will depend on your cardiovascular risk factors.

Discovering you’ve had an unrecognized heart attack might feel unsettling, but the information can be useful. Ideally, the knowledge may give you extra incentive to follow a heart-healthy diet and get regular exercise. But medication changes may also be warranted. For example, if your LDL cholesterol is above 70 milligrams per deciliter, you should take cholesterol-lowering drugs (or increase your current dose). Your physician also may suggest a lower blood pressure goal. If you have diabetes, you may be advised to switch to one of the newer diabetes medications (known as SGLT-2 inhibitors and GLP-1 receptor agonists), some of which also prevent heart attacks and strokes, says Dr. Giugliano.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

2 Corinthians 13:9 For we rejoice when we ourselves are weak but you are strong; this we also pray for, that you be made complete.

Colossians 1:28 We proclaim Him, admonishing every man and teaching every man with all wisdom, so that we may present every man complete in Christ.

Colossians 4:12 Epaphras, who is one of your number, a bondslave of Jesus Christ, sends you his greetings, always laboring earnestly for you in his prayers, that you may stand perfect and fully assured in all the will of God.

2 Corinthians 10:15-16 not boasting beyond our measure, that is, in other men’s labors, but with the hope that as your faith grows, we will be, within our sphere, enlarged even more by you, so as to preach the gospel even to the regions beyond you, and not to boast in what has been accomplished in the sphere of another.

2 Thessalonians 1:3 We ought always to give thanks to God for you, brethren, as is only fitting, because your faith is greatly enlarged, and the love of each one of you toward one another grows ever greater;

2 Peter 3:18 but grow in the grace and knowledge of our Lord and Savior Jesus Christ To Him be the glory, both now and to the day of eternity. Amen.

Ephesians 1:17-18 that the God of our Lord Jesus Christ, the Father of glory, may give to you a spirit of wisdom and of revelation in the knowledge of Him. I pray that the eyes of your heart may be enlightened, so that you will know what is the hope of His calling, what are the riches of the glory of His inheritance in the saints,

Ephesians 3:16-19 that He would grant you, according to the riches of His glory, to be strengthened with power through His Spirit in the inner man, so that Christ may dwell in your hearts through faith; and that you, being rooted and grounded in love, may be able to comprehend with all the saints what is the breadth and length and height and depth, read more

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