Why are asymptomatic heart attacks increasing at an alarming rate and how to prevent them?Know your risk factors

Another 50-year-old smoker had a history of exertional shortness of breath and wheezing, and had been treated for asthma with no noticeable response. This gentleman was again referred to me for evaluation which revealed his heart failure as the reason for his symptoms, which was due to an asymptomatic heart attack. He improved with heart failure treatment and proper management of his coronary artery disease (CAD).

Incidental findings are common in medicine and often lead to dilemmas of diagnosis and management. One such troubling group of patients — asymptomatic individuals who turn out to have previously undiagnosed heart attacks or silent myocardial infarctions (SMIs) — are becoming ill at an alarming rate. Morbidity is increasing.

People often don’t realize they’ve had an asymptomatic heart attack until a health care provider discovers heart damage weeks or months later. It can be difficult to identify an asymptomatic heart attack when there are no symptoms. However, it is of great concern because, like any heart attack, it causes damage. Asymptomatic heart attacks do not cause noticeable symptoms, so patients may not recognize them.

What is Silent Heart Attack?

A heart attack is called “silent” when there are no symptoms, mild symptoms, or symptoms not related to a heart attack. Because the symptoms of SMI are so mild and so brief, they are often confused with normal discomfort and other less serious problems, and are very commonly dismissed as “gas,” flu-like symptoms. and ignored.

How does Silent Heart Attack affect the body?

The heart needs oxygen-rich blood to function. This blood flow is greatly reduced when plaque (containing cholesterol and other substances) builds up in the walls of the arteries that supply blood to the heart. If a blood clot blocks the lumen of an artery following plaque rupture, causing a heart attack, it can completely block blood flow. Rarely, coronary artery spasm blocks blood flow. The longer the heart is without blood flow, the more damage occurs.

Because SMI is painless, people may not know they have had a heart attack and may not seek medical attention immediately. Without timely treatment, an asymptomatic heart attack can be fatal. These can occur during sleep or while fully awake. It can also occur when you experience something very stressful physically or emotionally, or when you become physically active quickly, or even when you are physically active outdoors in the cold. According to a 2018 study And those who have had asymptomatic heart attacks have the same long-term survival rates as those who have had regular heart attacks. The authors found that about half of all silent heart attack survivors died within 10 years of the incident. This is the same rate as other heart attack survivors. However, people who have had an asymptomatic heart attack are at risk of other complications, such as heart failure and stroke. Another 2018 study found that people who have had an asymptomatic heart attack have an estimated 35% higher risk of heart failure than those who have never had a heart attack. People in their early 50s or younger are even more at risk.

How common are asymptomatic heart attacks?

It is estimated that 50-80% of all heart attacks are asymptomatic in various populations. According to the American Heart Association, SMIs account for approximately 170,000 of the estimated 805,000 heart attacks in the United States.

Who does Silent Heart Attack affect?

Asymptomatic heart attacks are presumed to be more common in women, the elderly, and diabetics. Risk factors for asymptomatic heart attacks are the same as those for recognized heart attacks and include:

high cholesterol
high blood pressure
Obesity and lack of exercise
smoking
Year
family history of heart disease
unbalanced diet and lifestyle
Diabetes

Warning signs and symptoms

However, some people experience no symptoms or signs of an asymptomatic heart attack. Others may experience non-specific symptoms unrelated to heart attack.

・Indigestion

Feeling of tightness in back and chest muscles

・ Dyspnea

·dizzy

·nausea

・Fatigue, malaise, loss of appetite

・Sweating ・I have trouble falling asleep

Why are some heart attacks silent?

Mechanisms proposed to explain the development of silent myocardial ischemia include:

• Inability to reach pain thresholds during a heart attack.Some people may have a higher pain threshold than others

Reduced severity and duration of ischemic episodes (episodes of decreased blood supply)

● General sensory impairment to painful stimuli: In diabetic patients, the elderly, CKD, etc., nerve responses to pain are blunted due to neuropathy.

Increased beta endorphin and steroid levels mask symptoms

Higher production of anti-inflammatory cytokines that may block pain pathways and increase thresholds for neuronal activation

How is silent heart attack diagnosed

Bad news: Most SMIs fail to recognize the state and are diagnosed much later.

Good news: SMI can be easily diagnosed by:

·Physical examination

·electro-cardiogram

Echocardiography

blood tests such as cardiac troponin

・ Coronary angiography

CT coronary angiography

Cardiac MRI

· Stress test: Exercise/Nuclear

Management of asymptomatic heart attacks

Long-term management of patients with SMI due to obstructive coronary artery disease should be no different from the management of clinically recognized myocardial infarction. long-term prognosis. Optimal medical therapy with coronary revascularization by angioplasty or bypass surgery (to restore blood flow in blocked arteries) should be performed on the advice of a cardiologist.

Secondary prevention (prevention of future heart attacks) and prognostic assessment (tests to assess complications, treatment efficacy, and future risk) should be performed under the guidance of a cardiologist during regular follow-up. must be implemented. Secondary prevention includes risk factors such as lifestyle interventions (e.g., healthy diet, weight loss, regular exercise, smoking cessation), correction of hypertension, reduction of low-density lipoprotein cholesterol, and improved glycemic control in people with diabetes. starts with the improvement of

It’s best to know what’s normal for your body and seek help when you feel something isn’t right. Knowing the subtle signs of an asymptomatic heart attack can help identify it. You can also help yourself by treating medical problems that may lead to heart attacks. The long-term outlook depends on rapid diagnosis based on indicators of high suspicion.