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Understanding silent heart attacks

Ask the doctor

Q. I understand that some people experience a heart attack without realizing they’re having one. How are these heart attacks even discovered?

A. It’s true that about half of all heart attacks are what are known as silent heart attacks, meaning they are not associated with any symptoms. In fact, the person may have experienced symptoms, such as chest discomfort and dizziness. But the symptoms may be been mild and short-lived and therefore unnoticed or ignored.

Silent heart attacks are usually discovered on an electrocardiogram (ECG), which is a recording of the heart’s elec-trical activity. Damage to the heart’s muscle caused by a heart attack shows up as a distinct signature on an ECG.

These tests used to be done routinely even in healthy people, but professional medical societies no longer recommend this practice. ECGs sometimes reveal mild, nonspecific abnormalities that are not caused by underlying heart disease. Yet these findings may cause worry and lead to additional, unneeded testing and treatments.

But an ECG is often appropriate for people with risk factors or symptoms of heart disease (chest pain on exertion, for example). If an ECG reveals a silent heart attack, it should be taken just as seriously as a clinically diagnosed one, because a silent heart attack can predict a fatal one. People who discover they’ve had a silent heart attack should follow a heart-healthy diet, get plenty of exercise, and take medications as needed to lower their cardiovascular risks.

— Deepak Bhatt, MD, MPH
Editor in Chief, Harvard Heart Letter

Posted by: Dr.Health

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