ASK THE DOCTOR - Silent Heart Attacks

Question: I recently heard about someone who had a “silent heart attack”. What is a “silent heart attack” and how can you tell if you have had one?

Answer: A heart attack, also known as a myocardial infarction, is a condition caused by a blockage in one or more of the blood vessels that supply the heart with oxygen. Blockage of these blood vessels deprives the heart muscle of oxygen and results in permanent damage to the heart and possible death. Common symptoms of a heart attack include chest pain that may radiate into the shoulders, arms or jaw; shortness of breath, sweating, dizziness and nausea. Less common symptoms include abdominal pain, severe fatigue, or an impending feeling of doom. Anyone having these symptoms should seek emergency medical attention; unless that feeling of impending doom occurred while doing your taxes – I consider that quite normal.

Many people assume that everyone having a heart attack will have chest pain when in fact only about 50% of people having a heart attack will experience typical chest pain. Patients older than 65 as well as those with diabetes are less likely to have typical chest pain at the time of a heart attack and are more likely to report vague symptoms such as fatigue or indigestion like symptoms. Some patients have heart attacks without any symptoms, when this occurs it is referred to as a “silent heart attack”.

An electrocardiogram (EKG) is a test that can determine if a patient has had a heart attack in the past. In one study done on elderly patients, 21-68 % of patients with EKG evidence of a prior heart attack had no known prior symptoms. Many people mistakenly think of heart disease as being more common in men than women. According to the CDC; heart disease is the leading cause of death in both men and women accounting for a nearly identical 27% of all deaths in both men and women.

Patients with risk factors for heart disease such as smoking, hypertension, diabetes, elevated cholesterol, obesity or a family history of heart disease should discuss their condition with their physician to determine if they should undergo evaluation for silent heart disease. All patients should seek emergency attention whenever they experience chest pain or any of the other warning symptoms of a heart attack.

If you would like to submit a question please contact Jennifer Trebler at jtrebler@ramonavna.org.

ASK THE DOCTOR - Asthma

Question: “I have never smoked in my life but I notice that when I am around other people smoking I have difficulty breathing. A friend told me I might have asthma. What is asthma and why do I have problems when I am around cigarette smoke?”

Asthma is an episodic disease of the lungs in which certain trigger factors cause the airways to become swollen, produce excessive mucus, and tighten or constrict. Common symptoms of asthma include chest tightness, shortness of breath, coughing and wheezing. The severity of an episode may vary from mild shortness of breath to severe symptoms requiring hospitalization. I have been told that having an asthma attack feels like having your nose plugged and trying to breathe through a straw while jogging.

Asthma episodes may be triggered by irritants, allergens, or stress. Common examples of irritants include tobacco smoke, smog, cold air and perfumes. Allergies such as hay fever or sensitivity to pet dander can trigger asthma attacks in certain individuals as well. Exercise induced asthma is characterized by wheezing triggered by strenuous physical exertion and some people have asthma attacks triggered by emotional stress. In children, the most common triggers are viral illnesses such as the common cold.

There is concern about the number of patients who self diagnose and use over the counter asthma medicines such as Primatene Mist®, which contains epinephrine. While it is true that epinephrine will help open your bronchial tubes; it also places a significant stress on your heart and may cause serious side effects if you have a heart condition.

If you feel you might have asthma, please consult your doctor. 
If the diagnosis is in question, the doctor can order testing to determine if you have asthma or some other respiratory problem and can prescribe medications to relieve your symptoms. There are many safe and effective medications to treat asthma. If you are concerned about the cost of the medication, ask your doctor to prescribe a generic medicine. There are generic asthma medicines available starting at $4.00/month (Albuterol nebulizer solution); compared to $17.99 for one Primatene Mist® inhaler.

Asthma can be controlled and does not need to limit your activity level. For example, world-class swimmer Peter Vanderkaay has had asthma since age 10. Despite his condition, he received bronze and gold medals at the 2008 Beijing Olympics.

If you would like to submit a question please contact Jennifer Trebler at jtrebler@ramonavna.org.