[SMC Magazine ‘নোঙর’] Silent Heart Attack – The Silent Killer: Dr. Sifat Jubaira

A heart attack does not always have obvious symptoms, such as pain in your chest, shortness of breath and cold sweats. In fact a heart attack can actually happen without a person knowing it. It is called a silent heart attack, or medically referred to as silent ischemia (lack of oxygen) to the heart muscle.

Symptoms of a silent heart attack
As the name implies, a silent heart attack is an attack that has either no or minimal or unrecognized symptoms, but 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.

People who have these so-called silent heart attacks are more likely to have non-specific and subtle symptoms, such as indigestion or a case of the flu, or they may think that they strained a muscle in their chest or their upper back. It also may not be discomfort in the chest; it may be in the jaw or the upper back or arms. Most heart attacks occur during several hours — so never wait to seek help if you think a heart attack is beginning. In some cases there are no symptoms at all, but most heart attacks produce some chest pain. Other signs of a heart attack may include shortness of breath, dizziness, faintness, or nausea. The pain of a severe heart attack has been likened to a giant fist enclosing and squeezing the heart. If the attack is mild, it may be mistaken for heartburn. The pain may be constant or intermittent. Also, women are less likely to experience the classic symptoms of chest pain as compared to men thus are more prone to silent heart attacks.

General measures before patient is shifted to a hospital or a medical center
1.  Have the person sit down and calm him/her. If clothing is tight then loosen it.
2.  Immediately transport to the nearest hospital or ambulance service. Do not leave the person alone.
3.  Nothing should be given except for sublingual tablets or any other medication prescribed by the doctor. A tablet of aspirin helps person to limit the damage.
300 mgs of aspirin chewed at the time of heart attack can reduce the mortality by 15 to 20 per cent.
4. Make sure the patient continues breathing and has a pulse until the ambulance arrives or the patient reaches the emergency department of a hospital.
5. If there is no breathing or pulse, give Cardiopulmonary Resuscitation (CPR). Immediately place the palm of your hand on the patient’s chest just over the lower part of the sternum (breast bone) and press your hand in a pumping motion once or twice by using the other hand. This may make the heart beat again. If possible, raise the legs up 10 to 15 inches to allow more blood to flow towards the heart.
It should be remembered that prompt recognition and diagnosis of a heart attack is the key and such patients should be rushed to the nearest hospital without any delay. Delay can be fatal.

Diagnosis of silent heart attack
Because a silent heart attack does not produce symptoms that send the patient to seek medical help, the diagnosis is only made after the fact — after the damage has been done.

Usually, the doctor is able to detect the cardiac damage that has resulted from the heart attack by examining an electrocardiogram. The diagnosis can be confirmed by performing an echocardiogram, in which the now-weakened heart muscle can be visualized.

The stress test can serve two important purposes in people who have had silent heart attacks. First, it may allow your doctor to measure the “threshold” of exercise that produces ischemia (normal heart attack symptoms) in your case. That is, your doctor may be able to give you specific instructions regarding which activities are safe for you to perform. Since you cannot use the onset of angina (chest pain) as a warning that you are doing too much, this kind of advice can be very important.

And second, when ischemia occurs during a stress test, even people who have had silent heart attacks and/or silent ischemia will often feel “something,” even if it is not typical angina. So the stress test can give important feedback to people with silent ischemia — it can teach them that “this is what ischemia feels like in your case.” In the future, whenever you experience “this” sensation — whether it is mild discomfort in the shoulder, shortness of breath, sudden fatigue, or whatever it may be — it means you are probably having an “angina equivalent,” and you should immediately stop what you are doing, and follow your doctor’s instructions for treating angina (for instance, taking a nitroglycerin tablet).

Prognosis (outlook)

Heart attacks may be rapidly fatal, evolve into a chronic disabling condition, or lead to full recovery. The long-term prognosis for both length and quality of life after a heart attack depends on its severity, the amount of damage sustained by the heart muscle, and the preventive measures taken afterward.

Patients who have had a heart attack have a higher risk of a second heart attack. Although no tests can absolutely predict whether another heart attack will occur, people can avoid more heart attacks with healthy lifestyle changes and adherence to medical treatments.

• PDF Version [Published at SMC Magazine “নোঙর” May 2014]

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Dr. Sifat Jubaira. MBBS, M Phil, PGT The author is presently residing in Singapore since 2009 with two children and her husband Shakil Ahmed (29). She Graduated from Army Medical College, Rawalpindi,  Pakistan,  completed the Post graduation trainings and her Master Degree in Clinical Bio Chemistry from BSMMU, Dhaka. She is the author of several medical research papers published in BSMMU official medical journals. Prior shifting to Singapore with her family, she held the position of ‘Registrar’ in National Heart Foundation Dhaka.