Heart attack can cause various symptoms ranging from chest pain, shortness of breath to pain that radiates to the shoulder, arm, back, neck, jaw, and teeth; these are also the classic signs. However, heart attacks can also be ‘silent’, meaning it may either cause very few symptoms or lead to symptoms that are usually not recognised as a heart attack. This phenomenon is also known as a silent myocardial ischemia.
In a chat with the OnlyMyHealth team, Dr Pradeep Hasija, Consultant Cardiologist, Jaslok Hospital and Research Centre, Mumbai, discussed what a silent heart attack is and the warning signs that may often be missed.
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What Is Silent Myocardial Ischemia?
Silent myocardial ischemia is a condition that occurs when the heart does not receive enough oxygen-rich blood but does not cause any significant symptoms for instance angina or chest discomfort.
Dr Hasija said, “Almost 70-80% episodes of ischemia go unrecognised.”
Classifying the patients into three silent ischemia groups, he added, “It occurs in patients who are completely asymptomatic (Type I), who have suffered from a heart attack in the past (Type II), or those who have stable angina symptoms (Type III), where many episodes of ischemia take place without symptoms.”
Symptoms That May Be Overlooked
Some of the common symptoms of a silent heart attack that may get missed or overlooked include
- Prolonged and excessive fatigue
- Unexplained shortness of breath
- Indigestion
- Blackouts or syncope
- Unexplained fall
According to research published in the StatsPearl Publishing, patients with silent myocardial ischemia need an advanced diagnostic and therapeutic approach as they’re at a greater risk of developing new coronary events than those with no silent ischemia.
Who Is At Risk?
Risk factors for a silent heart attack or a silent myocardial ischemia are generally the traditional risk factors.
Research suggests diabetes mellitus is a significant risk factor for Coronary Artery Disease (CAD) and is associated with a higher incidence of silent myocardial ischemia. "Cardiac autonomic dysfunction is the main culprit in diabetic patients which involves pain receptors, afferent neurons or higher areas of the brain," the research further added.
Cardiac autonomic dysfunction is a common type of dysfunction in diabetes patients that results from damage to the nerves.
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Other common risk factors include:
- Age
- Obesity
- Family history of heart disease
- High blood pressure and high cholesterol
- Physical inactivity
- Prior experience with a heart attack
- Smoking
Additionally, Obstructive Sleep Apnoea (OSA) is also associated with an increased risk of myocardial ischemia - both silent or symptomatic. OSA is a sleep disorder that causes breathing issues while asleep.
Conclusion
According to the Mayo Clinic, imaging tests, such as an electrocardiogram or echocardiogram, are the only way to identify a silent heart attack. In the event of a silent heart attack, it is important to speak to a doctor to assess your risk factors and also work towards minimising the risk of another cardiac episode.