Having a heart attack and not knowing it

Factual Questions
21

The most immediate, and by far the most serious, problem is that as the tissue dies it starts to beat out of sync with the rest of the heart. And that beat will spread across the heart just like the natural beat. As the synchronisation between the damaged tissue and the pacemaker gets more and more out of whack, the risk of the contraction wave from the damaged tissue “cancelling out” the beat from the pacemaker increases.

If you can imagine a drum membrane, with one side being hit rhythmically by a stick, and the other side being struck randomly every few minutes by someone’s finger, you’ve pretty much got the picture. If the finger strikes well after/before the stick, the sound will be a little sketchy, but the main beat will be fine. But if the finger strikes a fraction of a second before or after the main beat, the beat will sound like crap as the two waves cancel each other out. In a drum the makes for a crappy sound.

Once that happens in the heart, the muscle just starts “quivering”. as contractions try to pass through the muscle only to meet the other beat coming the other way. At that point you are in fibrillation and without defibrillation will be dead within minutes.

That’s why most people die in the week *after *their “heart attack”, not at the time. The blockage itself has to be *really *massive to cause death, but even minor damage can set up an ectopic pacemaker that will lead to defibrillation as the tissue slowly dies over the following days.

Of course dead tissue is also problem because it become basically scar tissue. That reduces the force with which the heart can contract as well as reducing the ability of the heart to “reinflate” aft a contraction. As a result you end up with shortness of breath blood pressure problems etc., and in the long term the extra strain that places on the heart will kill you. Those aren’t good things, but they are not as serious and immediately life threatening as the pacemaker problem.

As for excising the tissue, their was an experimental treatment where they aneasthetised damaged heart muscle to prevent it from setting up its own beat. But I haven’t heard of it for years so I guess they don’t do it.

Never hear of anyone excising the tissue. Not sure why not. Maybe because the physical damage would be just as bad as damage caused by the loss of blood flow.

22

Double post.

23

No. The main nerve involved is the Vagus nerve, which ennervates the visceral cavity. It covers a wide variety of sensation, from the esophagus to the heart. This is why the range of sensation for a heart attack is so wide, and why so many are masked by other things.

I get spasms in my esophagus occasionally - if it strains a muscle it aches and is probably pretty similar painwise to a low grade heart attack, one of the things that prompted me to lose weight and get fit, to reduce the likelihood of a heart attack sneaking up on me masquerading as a spasm.

Sadly gurujulp’s last post illustrates the point - all chest pain should be treated as serious until otherwise diagnosed.

Si

24

Perhaps by making a recording of your heart (smartphone to the chest) then analyzing the sound? They can already analyze pics of moles and run them against a database to check for signs of skin cancer. An app for analyzing heart sounds should be here in a yaer or two.

25

A colleague of mine had a “silent” heart attack, diagnosed by an EKG six months later (and followed by a bypass). When I had a heart attack, 47 years ago, I certainly had pain and was diagnosed by an EKG. Despite the claim made in several earlier posts, the heart muscle can sometimes heal. In two echocardiagrams I have had in recent years there was no evidence of scar tissue. The fact that I was 28 at the time presumably was the difference.

26

If that long considering they already have blood glucose meters

http://www.ibgstar.us/

27

Diagnosis of an MI is based on more than serum marker tests - medical history, physical exam, EKG etc. come into play. The blood tests are not 100% specific even when professionals run them; I can’t see test kit manufacturers wanting to market home tests for a life-threatening condition and later getting sued because they didn’t work or got misinterpreted. Besides, cardiac markers don’t even begin to rise until 2-3 hours after an MI commences. You don’t want to be pissing around at home waiting for test results during that time, when you could be getting checked out and emergency treatment started at the hospital.

Women very often do have “traditional” symptoms of an MI; it’s just that incidence of non-typical presentation is more common (as is the case for some other groups, i.e. diabetics).

28

What was the reason for a heartbattack at such a young age?

29

This, I didn’t know :slight_smile: Thanks!!

30

" A silent heart attack?!! OMG, I’m not having any chest pain at all! I could be having a heart attack right now!! You’ve got to DO something!"

Said to me by a patient at my old clinic years ago one evening. He came in after watching a TV news special about silent heart attacks.

:dubious:

31

At least it wasn’t a TV news special about silent farts.

32

This just emphasizes the question that people are asking here: Since heart attacks, even when symptomatic, are so often so subtle, just when should you decide to high-tail it to the ER?

I get minor twinges and pains, that otherwise “fit the description”, all the time, and that has been so for many many years. Should I stop by the ER daily on the way home from work just to get checked up on?

ETA: Yes, I have mentioned this to docs from time to time, and they all just pooh-pooh it.

33

When I was 18, my mom had a really rough week. Minor chest pain, coughing, that sort of thing. Then a few days later, she had a sudden, fatal heart attack. The doctor said that she’d likely been having small heart attacks all week long.

34

There’s an app for that.

35

Some interesting answers here…

Over the years I’ve diagnosed hundreds of heart attacks as an ED physician.

(May have missed a few; how would I know?)

If you take the standard layman’s term “heart attack,” you’re talking about dead muscle from a blockage in the arterial supply to part of the heart. Vascular distribution in the heart ranges from very large arteries such as the left main coronary artery, all the way down to a teeny tiny little branch off a diagonal or something. So how much muscle dies with a given occlusion depends on how much that particular artery served (assuming there’s no other collateral circulation into that area of muscle).

Dying heart muscle can give people pain, but not necessarily. Sometimes there’s no discomfort at all, and other symptoms range from vague tightness to shortness of breath to heartburn. So when we talk about a “silent” myocardial infarction, we might mean one that had symptoms but was mistaken for something else, or we might mean one with no symptoms at all.

The only absolute criterion would be autopsy slices to look for dead muscle, and you’d only see that if there was enough time for the muscle to die and/or scar. Lots of folks who die from a “massive” heart attack really died from an arrythmia associated with acute occlusion. Their heart muscle might look pretty normal if they died fast enough, and in fact it might have been a relatively small vessel. But we don’t like to tell people their loved one died from some crappy little heart attack, so that term “massive” is used a lot.

Other small occlusions leave such a small amount of scarring we don’t even see much evidence on a routine EKG. However the EKG can be useful, and it’s one way to see if a patient might have had an unrecognized heart attack. Particularly when the muscle is damaged through the full thickness of the heart (a “transmural” infarction), we’ll see typical changes of that on an EKG. Sometimes the muscle is badly injured enough to bulge out into an aneurysm. We can sometimes see that on an EKG, too. As well, various imaging studies that show the wall motion might suggest a prior heart attack if the damage was extensive enough.

In the acute setting, the EKG often changes dramatically, settling back down to normal or a scar pattern over time. Enzymes are released from damaged muscle, and we have some enzymes (Troponin I, e.g.) that are especially specific for the heart, so when they rise we suspect a heart attack. But over time the EKG can go back to normal, the enzymes return to baseline and the overall muscle works pretty good. So in those cases (although a perfusion study might pick up an area of old injury), the heart attack stays silent for good. A small scar seen only–if at all–at autopsy.

We only make a diagnosis of “silent” heart attack after the fact, and only when we stumble across evidence such as I have listed above, often serendipitously.

36

Ok, that just depressed the hell out of me and scared the shit out of me at the same time.

37

This whole thread has done that. :stuck_out_tongue:

38

My husband is in his early sixties, and he was outside playing with our granddaughter. He came in and was acting strangely. He gets migraines, and I asked him several times if he had a headache. He kept saying, “No,” but then finally admitted his chest hurt.

I told my daughter to call 911.

He was transported to the hospital, and connected to an EKG and had blood drawn for cardiac enzymes.

Everything came back normal, and the doctor said he’d probably pulled a muscle playing “airplane” with our granddaughter.

He felt STUPID about the whole thing. And every single person, the doctor, the nurses, and later on, our family doctor, all reiterated, “You have no reason to feel stupid. We’d MUCH rather you have it checked, no matter what!”

I know a man in his early fifties who worked at a lumber yard. He came home from his shift, said he was tired, and it felt like he’d pulled a muscle helping to unload a truck at work. He skipped dinner and went to bed.

His family found him in bed the next morning, dead from a heart attack.

So, I vote to have everything checked out.
~VOW

39

Who knows? Do heart attacks have reasons? However, I had been a moderately heavy smoker (a little over a pack a day) for about 12 years and never smoked another after that fateful day in 1965. My wife said that my complexion changed overnight from sallow to pink. My father who continued smoking after a heart attack at age 43 died 20 years later had the same sallow complexion. I have wondered if we were unusually sensitive to CO, which is certainly one of the components of cigarette smoke. Fortunately none of my kids (ages 39-46) has ever held a cigarette. Incidentally, when my wife got pregnant about 2 months after my heart attack, my doctor said, “When I prescribed bed rest, I don’t think you quite understood the concept”).

40

I’m 23 and in good shape so I suppose it’s highly unlikely that I would have any sort of heart trouble, but I do get chest pains every once in a while. I read online though that it’s not heart related if it changes with the position you’re in, which it does for me, so I’m guessing it’s just sore muscles (I’ve always worked jobs that require some sort of heavy lifting). It does make me a little nervous though- a friend’s older brother died suddenly while in college of an undiagnosed heart problem. But no doctor has ever mentioned hearing anything abnormal while listening to my heart and I don’t have any problems with physical activity so it’s probably nothing.