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What you should know about a silent heart attack

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Lao Tzu, the Chinese philosopher wrote, “Silence is a source of great strength.” Possibly sound advice in some situations, but for people who’ve had a silent heart attack, silence is far from a virtue. In fact, according to a report from the University of California, up to one half of heart attacks are totally silent! So, how dangerous are these myocardial infarctions, and what is the treatment?

The first indication of an attack may be when an electrocardiogram (ECG) is done for another medical reason and shows a damaged heart. But it may remain undiscovered until an autopsy reveals scarring in the heart’s muscle.

Why does the silent heart attack fail to cause symptoms? Some people have a higher threshold of pain than others. Or a higher blood level of endorphins helps kill pain. Or a smaller coronary artery is involved, causing less damage. Also, diabetes can cause degeneration of nerves.

In 2014, the Rotterdam Study, involving longitudinal research on a cohort of citizens, showed the silent attack is associated with a greater chance of dying from any cause, or from cardiovascular disease, for men and women over a period of twenty years, compared to no heart attack.

In another study, ECG evidence of a silent heart attack was associated with a triple risk of death from coronary heart disease and a 34% risk of dying from any cause over nine years, compared to someone without a heart attack.

It also noted that there was a greater risk among women than men for both types of heart attack. No explanation was given for this difference. Years ago, Dr Tirone David, one of the world’s great cardiac surgeons, stressed that by-pass surgery is more difficult in women because their coronary arteries are smaller.

An Icelandic study, published in JAMA Cardiology, showed what happened to cardiology patients over a thirteen-year period. During the first few years, those who had a known heart attack were more likely to die of any cause than those with a silent attack. But after ten years, silent heart attack patients were just as likely to have died as those who had a known attack.

This means that the silent heart attack can be as dangerous as painful ones. And since they’re so common, it’s prudent to try to prevent them.

What is the best treatment? A silent coronary occurs for the same reasons as one that causes pain. So, being obese, a smoker, diabetic, having high blood cholesterol, hypertension, and a sedentary lifestyle are all risk factors. Your doctor will suggest a change in lifestyle to eliminate them. A good start is a high fiber diet rich in fruits and vegetables, whole grains and unsaturated fats as found in fish and nuts.

Your doctor may suggest a 33 milligram Aspirin to decrease the risk of blood clot and should explain complications that may occur with this medication. You’ll know from reading past articles that omega-3 fatty acids decrease the risk of clotting, lower triglycerides, increase good cholesterol and decrease inflammation.

So, to Lao Tzu, silence may have its virtues, but it can also hide a serious medical problem. A good case scenario is that you get a diagnosis long before an autopsy. The best case is prevention, prevention, prevention.

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Written by W. Gifford-Jones MD & Diana Gifford-Jones

Dr. W. Gifford-Jones, MD is a graduate of the University of Toronto and the Harvard Medical School. He trained in general surgery at Strong Memorial Hospital, University of Rochester, Montreal General Hospital, McGill University and in Gynecology at Harvard. His storied medical career began as a general practitioner, ship’s surgeon, and hotel doctor. For more than 40 years, he specialized in gynecology, devoting his practice to the formative issues of women’s health. In 1975, he launched his weekly medical column that has been published by national and local Canadian and U.S. newspapers. Today, the readership remains over seven million.

His advice contains a solid dose of common sense and he never sits on the fence with controversial issues. He is the author of nine books including, “The Healthy Barmaid”, his autobiography “You’re Going To Do What?”, “What I Learned as a Medical Journalist”, and “90+ How I Got There!”

Many years ago, he was successful in a fight to legalize heroin to help ease the pain of terminal cancer patients. His foundation at that time donated $500,000 to establish the Gifford-Jones Professorship in Pain Control and Palliative Care at the University of Toronto Medical School. At 93 years of age he rappelled from the top of Toronto’s City Hall (30 stories) to raise funds for children with a life-threatening disease through the Make-a-Wish Foundation.

Diana Gifford-Jones, the daughter of W. Gifford-Jones, MD, Diana has extensive global experience in health and healthcare policy. Diana is Special Advisor with The Aga Khan University, which operates 2 quaternary care hospitals and numerous secondary hospitals, medical centres, pharmacies, and laboratories in South Asia and Africa. She worked for ten years in the Human Development sectors at the World Bank, including health policy and economics, nutrition, and population health.

For over a decade at The Conference Board of Canada, she managed four health-related executive networks, including the Roundtable on Socio-Economic Determinants of Health, the Centre for Chronic Disease Prevention and Management, the Canadian Centre for Environmental Health, and the Centre for Health System Design and Management. Her master’s degree in public policy at Harvard University’s Kennedy School of Government included coursework at Harvard Medical School. She is also a graduate of Wellesley College. She has extensive experience with Canadian universities, including at Carleton University, where she was the Executive Director of the Global Academy. She lived and worked in Japan for four years and speaks Japanese fluently. Diana has the designation as a certified Chartered Director from The Directors College, a joint venture of The Conference Board of Canada and McMaster University. She has recently published a book on the natural health philosophy of W. Gifford-Jones, called No Nonsense Health – Naturally!

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The fine line between truth and theories has been getting more and more blurred

Building the Canadian Shield; an illogical and irrelevant strategy, or a solid plan?