Have I had a heart attack?

Factual Questions
1

I’m a participant in a study concerning the correlation of type 2 diabetes (which I have) and cardiovascular disease (which I didn’t think I had), and as part of the baseline testing I was given an EKG. I’ve had EKGs in the past, and no one mentioned any problem. This time, the doctor who is heading the study at this site looked at my EKG, and asked me, “when was your heart attack?”

I replied, “I’ve never had a heart attack.”

He said, “Oh yes you have, but not recently.” He couldn’t be more specific than that.

Now first of all, I’m wondering how he can determine this from a single EKG, not having a “before” picture for comparison. Could what he saw be just some anomaly that I was born with, rather than a cardiovascular event?

I can think of two instances that, in retrospective, might possibly have been heart attacks - one at least 15 years ago, and the other 11-12 years ago. In both cases I experienced profuse sweating, nausea, shaking and dizziness/lightheadness, and in both cases I was ok after several terrifying minutes, without medical help. There was no pain or tightening in my chest.

If those two experiences weren’t heart attacks, I guess it’s possible that I had one in my sleep and never knew it.

So is it possible to have a heart attack and not know it? And more importantly, is it possible to have survived it without any kind of medical intervention - especially one severe enough to leave evidence for many years?

By the way, I have made an appointment for a stress test.

2

It is definately possible to have a heart attack without knowing it, as my neighbour did about two years ago. When he finally went to the doctor’s it was about two days later, connected to what he thought was a badly pulled muscle in his arm. Obviously the specialist he saw at the hospital had some way of identifying the condition after the event, however, that was only about five days later.

3

Yes, it’s quite possible to have a heart attack without knowing you’re having one. And it’s also possible for such a heart attack to cause recognizable changes on your EKG (a heart attack doesn’t have to be very severe to lead to permanent EKG changes). Based on what you said in your post, an evaluation by a cardiologist would be a very good idea.

4

In very basic terms, EKGs measure the creation and conduction of electrcal signals in the heart. As the heart goes through one “beat cycle”, it initiates an electrical current that not only travels through the heart, but also travels to the surface of the body (where it can be detected by those little sticky pads with wires on them).

In a normal and perfectly healthy heart, the signal appears in a certain way (the typical up and down wave that you’ve seen on TV programs and is the squiggly graph on paper that you might have seen). But if anything interfers with the conduction and propagation of the wave in the heart, the pattern doesn’t look the same as a normal heart.

There are many reasons that the pattern might look different than a normal heart. For example, in a “heart attack”, some heart muscle tissue might die, and therefore the electrical signal will not be conducted normally through that part of the heart. Therefore, the signal picked up by the EKG will look different, and a trained professional might be able to say “So, when did you have a heart attack?”

I hope this very simplified explanation helps. I am not a Dr (anatomy instructor). I strongly urge you to have an evaluation by a cardiologist.

5

There are a number of distinct changes on an EKG that indicates prior mycardial damage. As with everyone else, I would go see a cardiologist, if I were you, or if it was me.

6

How often does a heart attack leave a trace (changed EKG signature) like that? I went to a doctor about a possible heart problem, got an EKG and was told I’m perfectly fine, can I be reasonably sure that I’ve never had a heart attack?

(I’m just curious, I’m not old enough for it to be a major concern.)

7

Also remember an EKG will not predict IF you WILL have a heart attack it can only show what you have had.

I knew one lady that kept looking to me as if she was having a stroke and sure enuff about 3 months later she was told she had a mild one.

Check it out EKGs can be misread too.

8

There are changes that happen during a heart attack on an EKG that go away shortly thereafter, and others that linger around indefinitely. Not all heart attacks lead to distinct changes on EKG later on–they can often be “non-specific” changes. When they are in a particular pattern, though, you can be fairly sure that someone has had a heart attack in the past.

Diabetics are famous for having silent heart attacks–whether that is backed up by studies, I’m not sure, but it makes sense. As you probably know via your study and elsewhere, heart disease and diabetes go together like the proverbial horse and carriage. We often treat someone with diabetes the way we’d treat someone who has already had a heart attack in terms of prevention, whether he has had one or not.

The stress test sounds like a good idea.

Dr. J