Heartburn or Heart Attack? A cautionary tale.
I call my Pop nearly every night since his wife died. That night, he told me that he woke up in the middle of the night feeling sick to his stomach and sweating. Not really a big deal, because New Jersey weather at the end of July is the worst for sweating, but being me, I as I asked a few more questions, and I grew more and more concerned.
Did he have the air conditioning on? Yes.
How bad was he sweating? Bad enough to need a shower and a change of clothes. Hmm...
How bad was the nausea? Bad enough to cause a little vomiting. Now I was more concerned.
Then I asked the million dollar question. “Pop, did you have any chest pain?” There was hesitation on the other end of the phone. “Well, it wasn’t really pain, but it was more of a sensation in my chest.”
My stomach fell. “How long did it last” “I was up a few hours with it, but then I fell asleep and then the next day I was fine and I mowed the lawn.”
I knew right then that my Pop had a heart attack. Little did I know that the hard part was going to be convincing him and his doctors that he did actually have a heart attack in the absence of chest pain, or other pain. I had to push to get him the needed test for troponin, to show heart muscle damage had indeed occurred.
Although media leads us to believe the typical heart attack has the victim clutching their chest in pain and falling to the floor, as many as 40% to 60% of all heart attacks can be “silent” or undiagnosed by the people who have them. These are labeled “unrecognized myocardial infarctions” by the clinicians who study them. [Kannel WB, Abbott RD Incidence and prognosis of unrecognized myocardial infarction. An update on the Framingham study. N Engl J Med 1984;311:1144–1147.]
An ischemic heart attack occurs when the arteries that supply the never-stopping oxygen-hungry heart muscle are unable to get blood because of a blockage. The blockage can be from cholesterol build-up over years or a sudden blood clot. In Pop’s case, an angiogram showed that all of his arteries were completely clogged with cholesterol, and he was scheduled immediately for a quintuple bypass. This was a shock, as his cholesterol levels were low and he had no symptoms whatsoever. But it turns out that lack of angina, or chest pain, is actually a significant predictor of silent heart attack with other factors. It may be that when you don’t have the chest pain, the heart attack is overlooked, by both the doctor and the patient. They simply pop a Tums, and go mow the lawn. [Sheifer, SE, et al. Prevalence, predisposing factors, and prognosis of clinically unrecognized myocardial infarction in the elderly. J Am Coll Cardiol. 2000;35(1):119-126.]
Unrecognized myocardial infarction, or silent heart attack is of clinical significance because this condition is generally missed by the cardiologist and these patients are at greater risk for future death. [Chow CK, et al. What Is the Significance of Unrecognized Non-Q-Wave Myocardial Infarction? PLoS Med 2009;6(4):2009 e1000060.] Knowing your own body, and paying attention and tracking your symptoms, and not trying to be a “tough guy or gal”, and power through an illness is important. Heart disease is still the number one killer in the United States, and even though silent heart attacks have “been around” for 30 years, many of us still aren’t listening hard enough.
Pic somewhat related