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Medical Intel

Sep 27, 2018

Nearly 25 percent of all heart attacks might be silent myocardial infarctions, or silent MI. These heart attacks can cause serious, long-term damage without any noticeable symptoms. Dr. Allen Taylor discusses who is at risk for this condition and how to prevent it.



Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine.

Host: Thank you for joining us today. We’re talking with Dr. Allen J. Taylor, Chief of Cardiology at MedStar Heart and Vascular Institute at MedStar Washington Hospital Center. Today we’re talking about silent myocardial infarction, or silent MI, which is a heart attack that goes unnoticed by the person who has it. Silent MI might have no symptoms, or the symptoms might be so mild that they’re mistaken for muscle pain or heartburn. But the lack of symptoms is deceiving. Research has found that Silent MI, without a history of traditional heart attack, increases a patient’s risk of heart failure, heart attack, and death in general. Dr. Taylor, how can a condition that feels and seems harmless be so dangerous?

Dr. Taylor: Silent MI is an unrecognized problem. It’s the same as a recognized heart attack, in terms of its risk. Seems surprising, how can something silent be so dangerous. And it’s not just the recognition that’s the problem, in terms of risk, but it’s the fact that when not recognized, we don’t have an opportunity to apply the right treatments that improve outcomes. So, silent MIs are risky and they’re just as risky as MIs that patients recognize. So, it’s important that we find them and get patients on the right treatment.

Host: Are silent MIs common?

Dr. Taylor: So, about a quarter of heart attacks are thought to be silent. And I think that when we use the word silent, we have to explain a little bit. Cause some MIs are truly silent - the patient never even has a symptom. Some MIs are unrecognized and so, silent to the patient, although there was a symptom that the patient didn’t recognize as being typical for a heart attack. Patients may mistake their symptoms - for instance, they may say “Oh, that’s just heartburn”, or they may experience heart pain as back pain. Or, in older patients in particular, they may simply have no symptoms at all or simply be feeling down or fatigued or just “off” a particular day. We hear all these stories and, whether it’s truly silent or unrecognized, it’s about 1 in 4 heart attacks that occur in the community.

Host: How are silent MIs detected if they cause no symptoms?

Dr. Taylor: Detection of unrecognized or silent MI can be a problem because it takes a test to detect it since the patient didn’t experience warning symptoms. Some ways we’ll identify them are using a simple test such as an electrocardiogram, that if it shows the changes of a heart attack, that we would then do further investigations to confirm if the electrocardiogram was true or not. Electrocardiograms can be very useful tests in detecting heart attacks that have been unrecognized, although it’s important to note that there’s both false positive test as well as negative tests. So, the electrocardiogram is not perfect, but it’s our primary tool to detect them. Another test that is very common in use is a heart function test called an echocardiogram. It’s a test using sound waves that looks at the heart function and if an area of the heart was shown to be not functioning properly, we might suspect that it had been impaired by an unrecognized heart attack. And that might lead to further investigations to determine if that was true or not. But the detection is difficult. And so, it takes going to your doctor and having one or two of these tests to see if your heart’s in really good shape.

Host: What happens after you discover that a patient has experienced a silent MI?

Dr. Taylor: Well, the first thing I say is “Don’t panic.” Let’s dive a little deeper into this. But, what happens then is we’ll just basically use the same evaluation as someone that had a known heart attack and run them through generally simple tests to see. For example, if the EKG or ECG electrocardiogram was abnormal, we’d perhaps get an echocardiogram to see if the heart function was ok. And then maybe a stress test - having somebody walk and then lightly jog on a treadmill while placed on an electrocardiogram to see if that shows any signs of heart stress when being active. And, if that’s not enough, we have very sophisticated tests that we can really dive very deep into heart function and to make sure the arteries are in good shape or, if not, what the depth of the problem is. So, it’s really the same evaluation as someone who has a known heart attack. And if we find there’s truly an abnormality, what then begins, after it’s assessed, is pick the right treatments. Does someone need an artery treatment right up front, and clearly then we’ll move them on to the right preventative treatments to prevent anything further from happening.

Host: Who’s at risk for silent MI and should patients worry?

Dr. Taylor: It really can be anyone because if it’s truly silent or unrecognized, any of us could mistake, say back pain, for back pain when it was really truly a heart attack. But there’s a few patient populations we’ve really focused on. One would be patients with diabetes. The patients with diabetes often don’t feel pain in the same way. And, they truly can be silent, or they may even experience a heart attack in a day when they simply don’t feel well and maybe their blood sugar control gets worse all of a sudden and they can’t figure out why. In an older patient, particularly in older females, the heart attacks can also be truly silent or unrecognized because they present in odd ways like back pain or a day in which they feel tired or just simply off. But it’s important to know that if anyone is feeling any symptoms that are unexplained - heartburn that’s just a little different than the usual heartburn they’ve experienced and longer lasting - they shouldn’t assume it’s heartburn, but get seen promptly to make sure that, nothing’s going wrong with their heart.

Host: What can patients do to reduce their risk of silent MI?

Dr. Taylor:  In terms of reducing the risk for it, well it comes down to the core risk factors for heart disease. That is, high blood pressure, high cholesterol, diabetes, tobacco use, and then leading an optimal lifestyle, regular exercise 30 to 60 minutes most days of the week, avoiding tobacco, eating a diet that’s low in fat and low in sugars. So, it’s a lifestyle approach. Really, knowing your numbers and leading a healthy lifestyle to prevent it. But then not taking symptoms that you think are a little funny for granted.

Host: Why is MedStar Washington Hospital Center the best place to seek heart care?

Dr. Taylor: Well, I’m very proud of what we do at MedStar Washington Hospital Center and MedStar Heart and Vascular Institute because we simply can take care of anything from the most simple to the most incredibly complex. And we have every possible diagnostic tool to help uncover heart disease and every possible tool then to treat it. No matter the severity, we have a team that can help and that’s another unique aspect of MedStar Heart and Vascular Institute is that when you see one person, you’re really seeing an entire team. An entire team of experts that work together for making your care optimal.

Host: Could you share some success stories from your patient population?

Dr. Taylor: I have an interesting case - a young man, he’s very overweight but he had come in the hospital in terrible shape and things weren’t quite right. And in fact, in looking at his electrocardiogram, we noticed that there were signs of an old heart attack. And, in fact, what we indeed found in investigating it, was in fact he had an artery that was totally blocked, and it really had helped contribute to this whole illness that started with just a little breathing difficulty and retaining fluid. And by diagnosing the artery blockage, now we’re on a completely different course of care and now we’re seeking some really novel ways to restore blood flow past the total artery blockage. And while it’s unusual for a 30-year-old to have a blocked artery, it was the EKG that tipped us off and it’s really changed the way we’re caring for him. And, while I don’t want to alarm every 30-year-old person out there to say, “Oh my goodness, I could have a totally, artery totally blocked”, it raises the point of leading an optimal lifestyle. Good diet, exercise, maintaining good body weight, avoiding tobacco are the real ways to preserve your artery health.

Host: Thank you for joining us today, Dr. Taylor.

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