Breaking the silence on silent heart attacks

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Here are some preventative steps Malaysians can take to reduce their risk of getting a silent heart attack

FOR some, experiencing things in silence denotes a sense of calmness and tranquillity. Silence can be beneficial for many things: meditation, reading, even prayer. However, in other circumstances ‘silence’ can mean that something dangerous is brewing under the surface, something we do not always notice in time – especially when it comes to our health.

In line with this year’s World Heart Day theme of ‘Use Heart for Every Heart’, Sunway Medical Centre seeks to empower Malaysians to take care of their cardiovascular health by highlighting the possible dangers of a silent heart attack and how one can be swiftly spotted and prevented.

Dr Patrick Tiau, consultant cardiologist at Sunway Medical Centre, Sunway City highlights that in recent years, cardiovascular disease has remained the leading cause of death both in Malaysia and globally. “A key factor in this is that nearly half of all heart attacks are mistaken for less serious problems and can increase one’s risk of losing their lives to coronary disease,” Dr Patrick says.

Silent heart attacks, known as silent myocardial infarction (SMI), account for 45% of heart attacks. They are described as 'silent' because they occur without the usual, recognisable symptoms of a heart attack. Typical symptoms of heart attack include chest pain often described as heavy or pressure sensation; radiating pain in the arm, neck, or jaw; sudden shortness of breath; sweating, and dizziness might not be present. This has led to many not knowing that they experienced a heart attack until they receive diagnosis days or weeks after.

Dr Patrick says “We have come across many patients who have dismissed the early warning symptoms as simply feeling tired, indigestion, nausea or sweating. By the time they seek out medical treatment for these symptoms, they are shocked to learn that what they are experiencing is actually due to a reduced blood flow to their heart, and that has caused them to have a silent heart attack.”

Silent heart attacks are not benign as they can lead to a myriad of more serious health complications if left untreated over an extended period such as heart failure. If further neglected, it could also lead to an increased risk of another heart attack, which could potentially be deadly.

When assessing risk factors in different demographics, Dr Patrick explains that we can generally get a clearer picture by looking at two categories: non-modifiable risks vs modifiable risks, i.e., lifestyle adjustments.

Factors that cannot be changed (non-modifiable)

  • Age: The risk of experiencing a silent heart attack increases as an individual grows older.
  • Gender: According to a 2021 study[1], men are more susceptible to incidents of silent heart attacks than women. However, women are more prone to a higher risk of complications after experiencing one, especially if they are diabetic.
  • Genetics: People who have a family history of heart disease are at increased risk of a heart attack.

Factors that can be changed (modifiable)

  • Smoking: Chemicals in cigarettes stimulate one’s heartbeat and can dramatically increase one’s risk of heart attack.
  • High cholesterol: Individuals with elevated cholesterol levels can lead to formation of atherosclerotic plaque in the blood vessel and reduce blood flow to the heart.
  • High blood pressure: Having high blood pressure puts extra strain on the heart muscle which, over time, causes the heart muscle to stiffen, thicken and perform less optimally.
  • Body weight: Individuals who are overweight or obese, especially when their weight tends to sit at the waist, are more likely to develop heart disease even if they do not have any other risk factors.
  • Physical inactivity: Doing regular exercise helps protect the heart by keeping other risk factors in check, including cholesterol, blood pressure, diabetes, and obesity.

As with many critical illnesses, Dr Patrick advocates for Malaysians to take preventative measures first and foremost.

“Undeniably our heart health is essential to allowing us to have a well-balanced and fulfilling life. The heart itself is the first and last sign of life that is responsible for, quite literally, keeping us going. In combatting heart attacks, the most important thing to remember is that prevention is definitely better than cure,” Dr Patrick says.

Whether it’s a common or silent heart attack, even making small changes to our daily lifestyles can go a long way in reducing one’s risk factors. Such as regularly monitoring blood pressure and cholesterol; getting sufficient, aerobic exercise; quitting smoking; eating a balanced diet of fruit, vegetables, lean meats and whole grains, ensure that one’s blood pressure, cholesterol and blood sugar are well-controlled.

Most importantly, informing a doctor as soon as possible about any unusual symptoms can help diagnose silent heart attacks through specialised testing, such as with an ECG, echocardiograms, CT coronary or angiograms, as well as cardiac markers and exercise stress testing.

When it comes to heart health, preventative measures are preferable to any solution after a heart attack. – Pexels pic
When it comes to heart health, preventative measures are preferable to any solution after a heart attack. – Pexels pic

For patients who experienced a silent heart attack, Dr Patrick emphasises the importance of thorough cardiac evaluation and cardiac risks optimisation, which include the necessary prescribed medications.

“Once you go home from the hospital, it is essential that you keep taking your medications, as these will ensure your heart health is kept in check, possibly for the rest of your life.”

Amongst these medications, the most common types prescribed may include aspirin, statin and others such as beta blockers, and ACE inhibitors, depending on specific risk factors.

Dr Patrick also acknowledges the mental side of silent heart attacks that patients may go through. “After the stress of the initial diagnosis and recovery, you may start to develop feelings of shock, sadness, and anxiety,” he explains.  

He assures that this occurrence is normal, and it is important to remember that these feelings can pass with the right support. “Some people find it helpful to join a support group where they can talk with others who have been through a similar experience or seek out companionship and encouragement through avenues such as the gym, or yoga classes.”

A heart attack is one of the most unimaginably daunting things a person can go through, and what makes it even more so is that heart attacks can happen without us even realising. However, by educating ourselves through the right medical channels and by making sure we go for regular medical check-ups, we can ensure that our hearts remain beating strong and consistently for years to come.

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