When my Aunt Gert suffered a heart attack in her mid-70s, the examining doctor told her that it was not her first. Tests done to assess the damage to her heart revealed a section of dead muscle from a previous unrecognized heart attack. Sometime in the past, she had had what doctors call a “silent myocardial infarction,” or S.M.I., silent in that any symptoms she might have had at the time did not register as related to her heart and were not brought to medical attention.
My aunt was lucky. She survived her second heart attack and, by keeping cardiac risk factors under control, lived another two decades without further heart-related problems.
There are millions of people walking around in this country who, like my aunt, are oblivious to the fact that they have had an S.M.I. and face an increased risk of having another, more obvious one that could cause severe heart damage and possibly death.
You might think a silent heart attack is better than a recognized one: “What you don’t know can’t hurt you.” Unfortunately, it can. Although knowing you’re at risk of a heart attack can be emotionally distressing, not knowing can have much more serious consequences, prompting you to continue living in ways that endanger the health of your heart and your life.
A recognized heart attack is a wake-up call to adopt medical and lifestyle measures that can minimize cardiac risk, like normalizing blood pressure and cholesterol levels, quitting smoking, losing weight if you’re overweight, getting regular exercise and controlling Type 2 diabetes. If diet and exercise are not sufficiently protective, there are now many medications that can help nature along.
Even without medication, if everyone at increased coronary risk adhered to a heart-healthy lifestyle, “the incidence of heart disease would be reduced by 80 percent,” Dr. Rekha Mankad, cardiologist and director of the Women’s Heart Center at the Mayo Clinic in Rochester, Minn., told me.
Recent studies conducted in Iceland and Finland, which maintain excellent medical records on all citizens, have helped to determine how often S.M.I.s occur and the long-term consequences associated with them. The findings, published in JAMA Cardiology last October, highlight the critical importance of not waiting until your heart sends a clear message that its life-sustaining ability has been compromised; instead, acknowledge the presence of coronary risk factors and take preventive measures to bring them under control before it’s too late.
Perhaps most revealing was the very thorough study conducted in Iceland among 935 men and women initially aged 67 to 93 who were followed for up to more than 13 years. When they enrolled in the study, each participant underwent a noninvasive test called cardiac magnetic resonance imaging that can most reliably show whether a silent heart attack had already occurred. Initially, 17 percent were found to have had an S.M.I. and 10 percent had had a recognized attack. (...)
“A silent heart attack is not always so silent, but its symptoms — mild chest discomfort, heartburn, nausea, shortness of breath — happen to lots of people and are typically attributed to other causes and not brought to medical attention,” Dr. Robert O. Bonow, a cardiologist at Northwestern University Feinberg School of Medicine, told me. Women, whose symptoms are often vague, are especially unlikely to realize they are having a heart attack. (...)
“While screening with cardiac M.R.I. is not recommended, identification of risk factors certainly is,” he wrote in an editorial accompanying the Iceland study.
“It’s important for doctors to recognize people at risk and prescribe appropriate treatments to reduce that risk,” he said in an interview. “Although it’s human nature to ignore certain things until you have an event, adherence to preventive treatment can be lifesaving. In the United States, a heart attack is the leading cause of sudden death in people 65 and older.”
My aunt was lucky. She survived her second heart attack and, by keeping cardiac risk factors under control, lived another two decades without further heart-related problems.
There are millions of people walking around in this country who, like my aunt, are oblivious to the fact that they have had an S.M.I. and face an increased risk of having another, more obvious one that could cause severe heart damage and possibly death.
You might think a silent heart attack is better than a recognized one: “What you don’t know can’t hurt you.” Unfortunately, it can. Although knowing you’re at risk of a heart attack can be emotionally distressing, not knowing can have much more serious consequences, prompting you to continue living in ways that endanger the health of your heart and your life.A recognized heart attack is a wake-up call to adopt medical and lifestyle measures that can minimize cardiac risk, like normalizing blood pressure and cholesterol levels, quitting smoking, losing weight if you’re overweight, getting regular exercise and controlling Type 2 diabetes. If diet and exercise are not sufficiently protective, there are now many medications that can help nature along.
Even without medication, if everyone at increased coronary risk adhered to a heart-healthy lifestyle, “the incidence of heart disease would be reduced by 80 percent,” Dr. Rekha Mankad, cardiologist and director of the Women’s Heart Center at the Mayo Clinic in Rochester, Minn., told me.
Recent studies conducted in Iceland and Finland, which maintain excellent medical records on all citizens, have helped to determine how often S.M.I.s occur and the long-term consequences associated with them. The findings, published in JAMA Cardiology last October, highlight the critical importance of not waiting until your heart sends a clear message that its life-sustaining ability has been compromised; instead, acknowledge the presence of coronary risk factors and take preventive measures to bring them under control before it’s too late.
Perhaps most revealing was the very thorough study conducted in Iceland among 935 men and women initially aged 67 to 93 who were followed for up to more than 13 years. When they enrolled in the study, each participant underwent a noninvasive test called cardiac magnetic resonance imaging that can most reliably show whether a silent heart attack had already occurred. Initially, 17 percent were found to have had an S.M.I. and 10 percent had had a recognized attack. (...)
“A silent heart attack is not always so silent, but its symptoms — mild chest discomfort, heartburn, nausea, shortness of breath — happen to lots of people and are typically attributed to other causes and not brought to medical attention,” Dr. Robert O. Bonow, a cardiologist at Northwestern University Feinberg School of Medicine, told me. Women, whose symptoms are often vague, are especially unlikely to realize they are having a heart attack. (...)
“While screening with cardiac M.R.I. is not recommended, identification of risk factors certainly is,” he wrote in an editorial accompanying the Iceland study.
“It’s important for doctors to recognize people at risk and prescribe appropriate treatments to reduce that risk,” he said in an interview. “Although it’s human nature to ignore certain things until you have an event, adherence to preventive treatment can be lifesaving. In the United States, a heart attack is the leading cause of sudden death in people 65 and older.”
by Jane E. Brody, NY Times | Read more:
Image: Gracia Lam
