You can have a screening heart MRI for $40 in Milwaukee. You schedule it (no need for doc to do so) and you pay the $40 when you schedule. Results come to you which you can then share with your doc.
1
Treadmill stress testing is usually normal until there is an 80% or greater blockage in a coronary artery. Nuclear stress testing is abnormal when there is 70% blockage. Coronary Angiography (heart cath) is abnormal when there is 40% or more blockage. Each of these studies are important but are unable to detect early atherosclerotic coronary disease. Most heart attacks are caused by small cholesterol laden plaques that rupture and then form a clot suddenly blocking a coronary artery. Coronary Artery Calcium Scoring in usually abnormal when there is as little as 20% blockage. It is a safe and affordable and under utilized. It can greatly help to identify those asymptomatic patients in need of therapy to reduce those factors which cause plaque formation and contribute to plaque rupture.
2
in your article silient heart attack you quote a Dr. Bonow of Nothwestern University Feinberg School of medicine as saying "screening large groups of people for evidence of SMI is not economically or practically feasible at this time... ECG is not as sensitive as Cardiac MRI". Although true, that's like using a nuke to kill an ant. The problem is ECG, that is only capable of detecting at best, 44% of all common heart diseases, including SMI, and then only if the SMI interferred with the electrical signal of the ECG. THis is why American Academic of Family Practicioners recommends agains widespread screening - lack of effectiveness.
You might want to investigate a new technology from Cardio-Phoenix, they've developed a device similar to an ECG but it is able to detect 94% of all common heart diseases, including a broader range of SMI. No Cardiac MRI required. Simple, cheap, accessible, it is the heart diagnostic device long awaited to fullfill the dream of effective, cheap widespread screening. And it's clinically proven, in an FDA approves pivotal study of 560 patients in primary care. Imagine, patients where the doctors thought they knew their patients, had them tested with ECG, found 14% of them were FN, 7% FP. This shocked the GP's. in outpatient trial of 2600+ patients, the FN rate was 25%. 10 years in the making, this AI powered device is helping physicians understand heart disease and when to send their patient to the cardiologist. Soon, millions will be more aware.
6
Let's see....Parkinson's...dementia...cancer...Trump...
Yeah, a heart attack doesn't sound that bad if I gotta go.
(FYI, I am probably more likely to be run down in a crosswalk or on my bicycle by some "distracted" SUV-driving idiot texting or watching FOX news).
26
Another stealth marketing article fed to us by the health-industrial complex. The goal is for us to test more, have a couple of false positives, panic and test even more. No wonder it take 4-6 months to get an appointment with a cardiologist -- they are testing more and more of these paranoid patients who are clogging the system and preventing real patients the time at the clinics. No worries, there is always the emergency room, where one can get to see an ER physician before the specialist. Wonderful waste of healthcare resources and dollars.
10
@pinkdhr I wish I had been more “paranoid”. When I had my heart attack and almost died three years ago, with 100% blockage of my LAD. during the heart cath and stent implantation that saved my life, I was discovered to have previously had an SMI. The severity of my MI caused much damage to my heart. With an ejection fraction that now hovers around 30%, I needed an ICD to prevent the now much higher likelihood of going into cardiac arrest (might have been easier on the “system” if I had died, but I was 62 and not yet ready.)
My ejection fraction is low because I now have heart failure as a result of the damage during the MI and the cardiomyopathy also discovered at the time of my angioplasty. Wish I had been a bit more paranoid, as I had tell-tale symptoms of heart problems that I ignored. My family is very long-lived, without a history of heart disease. Wish I had had some of those tests so I could have panicked a little and done something about my heart disease, for example, a coronary calcium scan, which is inexpensive. I guess I wasn't one of your "real patients" until after I had the MI. The year of my heart attack and resulting heart failure, I was hospitalized 5 times. Total cost to the system......$250,000.
13
@pinkdhr, the real problem you alude to is that GP dont understand heart disease enough, and worse, dont know when to refer you to the cardiologist. And when they do, they have NO EVIDENCE no medical justification to provide the Cardiologist with the priority you need over others. its actually really hard. True, the cardiologists waiting room is full of healthy patients putting those in real need in the same queue.
Investigate Cardio-HART or CHART, its a new technology developed in Toronto, but proven in an FDA approved pivotal study conducted in europe. Imagine a device that is 94% effective at detecting and diagnosing all common heart diseases, versus the 44% of the current state of the art ECG device used in your doctors office or local lab. And this thing is cheap, easy to use and highly effective. Its a cross between and Echocardiograph (ECHO) and an Electrocardiograph (ECG). it can provide the medical justification you need to get to the front of the line or go to the back - at least now you and your cardiologist will know which it is. But dont look for it in Canada, the ridiculous rules by health canada will mean the rest of the world will get it long before it comes to Canada. Although FP are a bane, FN are the real problem, sent home thinking you are fine when the reality is the ECG you got is very limited in effectiveness. Imagine, 44% vs 94% for this new device. it'll give you back a little faith in GPs who really, are struggling with a very difficult issue.
3
@JEG in Raleigh. You're right, it would be nice if you could have been screened beforehand, and from age 40 according to a recent study done in NewZealand. Imagine how many $100 tests could be covered instead of $250,000 in costs to the system. Prevention is the key.
Yet this $100 test exists - today! You will see it soon in GP's offices because they are cheap, easy to use and super effective. It was AI enhanced to be the GP's cardiac assistant to help them know when to help you. Because heart disease is hard!
In the original article Cardiac MRI supper expensive, used only by specialists and you'll spend years trying to get one, unless your doing a study paid by the Cardiac MRI maker. It's like killing a butterfly with a battleship. A nice big and hugely expensive toy but not much more effective than the heart diagnostic technology I'm alluding too. But the real tragedy in your case, is what doctors call morbidity, the ongoing pain, suffering and lack of quality of life, not to mention the burden on family. No insurance or wrong insurance and your bankrupt, all because it is not recommended you get screened. An effective device fixes that problem, now can we get the medical community stop playing with multimillion dollar toys and focus on simple, affordable and highly effective techology. Your condition would likely have been diagnosed early enough to go into preventative treatement options. Become a messenger, keep talking about your story, you are not alone.
6
They asked JC, 'Caesar, you have seen men die in every manner possible. What then is the best way to die?' to which he replied without missing a beat, 'Unexpectedly.'
No man knoweth the day, nor the hour. I've always said I don't much care when or how it happens just so long as it's quick and painless as possible.
9
Great. Thanks.
3
I truly think that keeling over dead from Sudden Cardiac Arrest would be a blessing.
25
@Lilly S
Indeed. There are many fates worth than death and plenty of terrible ways to die. A few moments of pain than nothing or on to what's next ain't all that bad.
3
@Lilly S . the chances are you won't be so lucky and die easily. You'll likely end up with the med community calls morbidity, still living but long suffering. that good samaritan that saved you, to die another day. Now cursed, struggling, dependent on family, don't say friends, they'll pity you and you will never see them...
But you can easily avoid this outcome - a simple test can give you much hope.
but is you wait and eventually find out the truth of your fate, you'll find you still might want to cling to a few more days in this world.
But get the right test, because ECG is not enough, it never was, it has far too many limitations patients are never truly explained, because that the only device the GP has, that the GP is allowed to use in primary Care. Look for GPs that offer the device called CHART or Cardio-HART. That's a device that is cheap and highly effective. Then you'll know if you have to start writting your Epitaph.
2
All this is saying is that people at risk of heart attacks, who can be identified because they have had a silent one, are at risk of heart attacks.
Not a surprise.
6
Does anyone know if silent heart attacks occur in young athletes? Occasionally I hear of an sudden death and wonder what is the under lying cause.
3
@FreedomRocks76
Apparently it can be caused by inherited heart defects, congenital heart abnormalities, viruses and illness.
1
On June 1, 2006, I had a heart attack at the time I only knew something was happening, sweats, nausea, dizziness, trying to make it to the end of the hall, at the time I was unaware, I was home nursing my mother, she passed on June 9, 2006, so I automatically thought it was stress, fortunately, my niece happen to come to see if I needed anything and to spend time with grandma, never so happy to see her, went directly to bed and woke up later feeling like I had the flu but knowing I was to continue caring for my mom, so I went thru everything living off of adrenaline, and after the funeral I was just Beat and Tired, this went on for several weeks, walking short distances made me out of breath, several cardiac tests stated I had had a heart attack, an angiogram confirmed that I had a scar on my heart from the incident, so what I am getting at is when you are stressed and you have the above symptoms take care of yourself, 13years later I am great, have no real issues but occasionally wonder will it hit again, as this is also genetic for me.
13
@Rachel Quesnel Congratulations ! I think you may have written one of the longest sentences ever.
9
1. Genetics. 2. Luck. 3. Diet/lifestyle/exercise.
9
@Jon and life saving medication! 👍🏽
1
Perhaps depending on recommendations based on risk factors is exactly why people have S.M.I. and no one knows it. Why do we expect this to change? The recommendation leads back to the same old, same old.
This sentence points to a business opportunity to find an economical solution to this problem:
"Screening large groups of people for evidence of an S.M.I. is not economically or practically feasible at this time."
2
@Deb it's been done! check out Cardio-Phoenix out of Toronto. Their product is called, you're going to love this, Cardio-HART or ... CHART!
yep, been tracking them for 10 years. they've done it. Cheap and supper effective its the cross between an ECHO and and ECG... (look them up). and able to detect up to 94% of all common heart diseases. Saw them recently in Basel switzerland, at an AI trade show, and these guys rock. the device is clinically proven with years of clinical studies behind them with that one goal in mind, widespread screening of symptomatic and asymptomatic at population age 40+. Look for them. We need to encourage them to start deploying here and not stay in europe.
4
I found it interesting that experts recommend only Type II diabetics for intermittent testing. I’ve been a Type I, or insulin-dependent, diabetic for forty-two years. Even though I’m in good shape and never have had symptoms, shouldn’t I be tested?
I'm one of them, two months ago. 75 years. No history of heart issues, daily gym workout, and no symptoms except slight fatigue at end of my daily walk. Went to ER "feeling weird." After blood enzyme test, ER physician said I had a heart attack sometime in the last couple of day. Stents next day. Now it's all about the mental adjustment - not easy.
16
@Kent Kraus I had a similar experience nearly 5 years ago. Fortunately, I listened to my body and sought emergency care.
So thankful to receive a "warning".
3
My brother was diagnosed with two prior stokes at 46 when he to went to the doctor for the flu and mentioned a numb finger. He looked healthy as can be. After many subsequent stents and suitcases full of meds, he died young of heart failure, as our dad did. Now I’ve been diagnosed at high risk for a heart attack within the next 5-10 years, although I look 20 years younger than I am. No one is particularly concerned about it but me, as I am a woman. Don’t discount that factor, or a strong family history...medical professionals have biases. It’s up to you a lot of the time to be your own advocate, I had to insist on doctors paying attention for many years and am still not impressed. My daughter is a registered dietician and she’s helped much more than any MD so far.
13
It seems if you have the money for excellent healthcare then your diagnosis and treatment are going to have a far better outcome than the vast majority of the people in this country. I have a good healthcare plan, yet don't feel like I'm really getting good care. Too much emphasis on treating problems, too little time spent helping me to live a healthier lifestyle that would prevent problems.
Which actually makes sense, since our healthcare system is built to treat illness. Think about it....nursing homes depend on keeping elderly patients alive. Hospitals make the most money treating overweight unhealthy people with the latest advances in surgery etc. Drug companies sell more pills to sick people.
Imagine what would happen if we all ate a healthy diet, and exercised over our entire lifetimes, starting in kindergarten! More money spent on prevention and encouraging healthy choices, what a difference it would make.
Every time I go to the grocery store, the state of our healthcare is never more evident. How many lean people do you see with bad food choices in their grocery cart? How many overweight individuals do you see with terrible food choices in their carts?
Part of our health insurance should include mandatory exercise programs and cooking classes to teach people how to prepare healthy meals. Also if healthcare gave discounts to people who go to a gym & eat healthy, imagine the results. Just as good drivers pay less for car insurance.
29
@LovesGermanShepherds wow, you are making a huge assumption about over weight people. Many who are not overweight smoke, drink and, generally, make unhealthy decisions. Many who are overweight exercise and take good care of themselves. Choosing to single out a visible group without knowing anything about them is hubristic and ignorant.
19
@LovesGermanShepherds You are correct start early! Unfortunately some of us with familial hypercholesterolemia (high ldl from birth) don’t have a choice but to go on a statin to prevent CAD. One in 250 people have this and 90% are not diagnoses. In a way we are lucky to clear all the cholesterol out before it has a chance to build up! But yes early teaching on heart healthy eating and exercise is best for the young kids.
@LovesGermanShepherds
Weight management and help for those who struggle should be a big part of medical care. Now it is a commercial operation run by an industry that has designed it to make people fail.
3
Who are these American citizens who want to keep the health care insurance they now have?
My friend, a federal prosecutor in Florida, says they have great coverage that they can take with them when they retire. Not to castigate federal employees-- we should all have the same coverage as our senators and representatives, but is this why savvy pols like Pelosi refuse to back medicare-for-all ? She/they fear losing the votes of
2M Fed workers & 2.66M of those employed in private health insurance sector?
6
@pai gow
She fears losing the money donated to her and the DNC.
https://theintercept.com/2019/02/05/nancy-pelosi-medicare-for-all/
https://maplight.org/story/top-hospital-lobbyist-predicts-pelosi-wont-give-medicare-for-all-a-vote/
https://maplight.org/story/corporate-lobbyists-providing-more-bundled-donations-to-dem-congressional-committee
3
As usual ! Another article that is inaccurate and dangerously confusing because of all the generalization. As a cardiac patient / four stents in my heart/ I don’t appreciate it. In my opinion these articles do more harm than good. If the Times wants to enlighten people hire a cardiologist to write these pieces.
Heart Disease is called The Silent Killer. More than 50% of its “victims” are diagnosed when they are found dead on their kitchen floor.
I walk, I ride a bike, I am an excellent swimmer. I was never over weight. I do not eat junk food. All my cardiologists tell me I don’t even look sick- those are their exact words. Lucky me! Four stents and that was ten years ago on Thanksgiving when I was in the hospital drinking the brown juice they call coffee while I watched the Macy’s Parade. The doctor turned off the TV when he walked in, scowling and said your enzymes are elevated. We have to take you to a larger hospital. Now I look forward to each Thanksgiving more than ever as I watch the parade in my living room. Get a good cardiologist!!! Don’t read these articles. It will raise your blood pressure and that is not good.
35
@old lady cook
It raised yours. One size doesn't fit all - and this article wasn't meant for everyone. A neighbor of mine is 58, tan, fit, looks healthy as can be - and is dying of the disease. He has taught me that what really matters, what is really worth getting worked up over - all it is so very, very little. This article doesn't even fit on your radar. Again, take care of you...another Thanksgiving is about to arrive.
2
@old lady cook May I ask do you have fh (familial hypercholesterolemia) or a high LPA (lipoprotein little a)? I hope you are feeling healthy 😊. Most doctors do not check for a high lpa being an independent risk factor for CAD.
1
Similarly, when considering silent stroke, a "silent brain attack," clinical symptoms may be difficult to differentiate between cognitive, including memory, decline because of ischemic brain injury compared to incipient Alzheimer disease. Many patients have been found to have brain infarcts using MRI and had no clinical history of stroke. Brain infarcts are associated with poorer memory and other cognitive performance. Both silent heart attacks and silent brain attacks can be prevented, and often remediated, by a largely plant-based diet, including soluble and insoluble fiber, and moderate exercise. No refined oils, including coconut, olive, and MCTs, given they induce an inflammatory T-cell profile and neurovascular inflammation.
15
Nothing affects your health more than STRESS.
39
Sure this is an informative article, but how about using the owners manual approach to a symptom check list so I can easily understand what adds up to an S.M.I. and am able to distinguish it form other body functions disruptions. Ms Brody, if this article was written for me, the reader, I wouldn't have had to write this to you.
22
I am particularly interested in this article because I had open heart surgery a year ago, at age 70. I had no heart disease, though. I had a bicuspid valve that had created an aneurysm. Over time this resulted in a heart murmur which a urology PA (for real) detected. A cardiologist told me my first symptom would have been to die.
My cardiologist said I recovered faster than any other patient she had ever seen. Why? Because my wife feeds us a heart healthy diet, because we have been life long exercisers, and because we don't smoke. In the past decade we have averaged about 1 1/2 hours a day of cycling, hiking, swimming, dancing, etc.
I give my story because, although it is difficult to tell for sure, it appears from this article that whether or not a person has had an SMI the major determinant of preventing a heart attack is a heart-healthy lifestyle. Did I understand the article correctly?
Because of my heart-healthy lifestyle my heart adapted to its dysfunction instead of exploding. And it kept me going long enough for a symptom to appear--a murmur.
We all know what to do--eat right, exercise, lose weight, stop smoking. Do it or find your first symptom of a heart problem is to die.
19
No one gets out of this alive. If you're already in your 50's and relatively set in your ways, you're not going to change anything. Just enjoy your life and don't worry about all the scary stuff that is constantly thrown out by the news media. Scary sells.
A coward dies every day, a brave person just once.
12
Thanks for the total lack of clear recommendations! I now have no idea how to address this risk or collaborate effectively with my physicians, but at least I am worrying about it, Jane!
30
@Beth Leedham
Ask your GP to refer you to a cardiologist if you're worried about.
1
My father had a silent heart attack in 1991 at age 49. he thought it was just a bit of illness and he worked through it. He got sicker and went to the doctor, but it was mis-diagnosed. He finally went into the hospital, but it was too late and he died a few days later. The saddest thing for me is that my kids will never know their grandfather. Please eat well, don't smoke, and drink only in moderation. If you do feel sick, don't wait to see a doctor.
16
@Jimbo
"He got sicker and went to the doctor, but it was mis-diagnosed. He finally went into the hospital, but it was too late and he died a few days later."
It seems that everyone in your family was ok that he was
misdiagnosed. Heart disease is a number one killer and
if one of my loved ones was misdiagnosed which led to death, I would be suing. There's no excuse for a doctor who
misdiagnoses a heart attack in this country.
2
Don't worry, if you can't afford the test it's just gas. If you can you should definitely get it checked out.
12
I'm in my seventies. This past summer I paid attention to my symptoms: out of breath, tired to the point of thinking I had the flue. Had an echo cardiogram and the Dr. said no problem and I passed.
Knowing my own families medical history I pushed to have a stress test-truly expensive. Found some problem but, they weren't sure what it was. Sent me for a cardiac cath-even more expensive. Found right coronary artery 99 percent blocked. They put a stent in place. The surgeon said that my diet and exercise must have kept me healthy. I said I don't eat junk food and I don't smoke and I walk everyday. I asked about sex, and he said, "great exercise."
9
@Robert Shaffer -- Unstated lesson: if you have money your chances vastly improve.
19
@Robert Shaffer I am so happy I live in Canada. I don't have the added worry of not being able to afford the tests. It's a shame the US can't see it's way to universal health care. It would save lives.
16
Remember we spend a third of our lives sleeping: The heart attack can come and go without waking us.
9
I spend a lot of time in an assisted living facility and a memory care unit with my parents. We are fortunate in that they are high quality and the best situation one could hope for. When I read this type of health article, it seems like the unstated goal is to live as long as possible. Clearly it is important to have a good quality of life, but at some point organs will start to have problems. When I see the lives of most of the people in these facilities, it is not something I want for myself. This may sound harsh, but is it so bad to hit 80 and then have a heart attack and pass on?
42
@D Amen, "D". Everyone should have a right-to-die or make their own choices when they wish to die. No one should be forced to live beyond their capacity to accept excruciating and insufferable pain, their body breaking down and no functioning step-by-step. Of course, if they wish to live -- if that is living -- to the last minute of their existence, that choice should be honored the same why as choices-in-dying should always be honored. All the best in life's journey to you, D.
17
@D I'm with you! I'm almost 80, and I don't intend to end my life is some urine stinking facility surrounded by people who should have died but instead are wheeled around and fed and medicated until they run out of money.
5
As a scientist engaged in stroke research, I would like to add that the incidence of silent stroke is also problematic. Leary and Saver (Cerebrovasc Dis. 2003;16(3):280-5.) estimated that there are about 13 silent strokes for every symptomatic stroke. Silent stroke is considered to be a major factor in the development of cerebrovascular dementia.
23
While everyone is having a cardiac MRI with contrast, they can also have an MRI and MRA. That should keep healthcare cost reasonable.
6
@mark If everyone gets one then the costs per scan go way down.
@S That's not true at all. The issue isn't the equipment, it's the limited amount of neuro-radiologists. Until they create software to do the job - plotting and scanning the brain for problems - it's going to remain slow, costly, and not all that effective.
1
Comments are very interesting and some helpful. BUT I feel as if I am missing info from Ms. Brody... namely, is imaging more effective in revealing heart blockage than a stress test?
Now old, I find that conditioning still affects how much I can do. In other words when I walk up stairs with frequency it's easier than if I usually use the elevator. Diabetes 2 really plays havoc with your diet -- Mediterranean - not exactly -- carbs must be limited esp. the high density ones as well as all sugar. (Orange juice never.)
So much is genetic. Oldest living family member is 103! and living alone with limited help. Watching "Manor House" from PBS on Amazon Prime. A more accurate "Downtown Abbey." Fascinating - the issue of servants!
11
After scanning through all 137 comments no one mentioned Lipoprotein (a) which is expressed in 20% of the population. It is a significant cause of CVD. You can be doing all the right things, without the (and usually mitigated) risk factors and still have significant plaque and clot formation. It is not usually tested for due to not having an available reduction treatment yet. There is a foundation dedicated to its research and public education on this cause of CVD. This was my only risk factor and yet I had a HA at 62, by 2 blocked cardiac arteries and now have 2 stents. Blood levels are on a spectrum in individuals, the higher the level, the earlier in life the CVD. There is a simple separate assay from the usual lipid panel used for testing. Evidence indicates its expression is dependent on a single gene.
15
We just lost our youngest bother to this. Autopsy showed he probably had a silent heart attack and didn't know it at some time, and a few weeks ago he suddenly dropped and was gone. So important to find ways to check on heart as part of routine exams.
13
I would much prefer to drop dead of a heart attack than suffer the end of life set up in the US. Extending life for profit might be a crass description of our healthcare system, but all the herculean measures taken when the end is obvious and the patient wishes are ignored, are for money. Once you've witnessed the continued tests and machinations performed on a dying relative against their (and your) wishes because "medicare pays for it", dropping dead becomes an attractive option.
139
Jack, I thought that I might have been the only one who felt this way. I am terrified of what has become of medical practice in this country.
39
@Jack You bring up very good points. However, you might be surprised that most physicians, like myself, don't want to extend suffering unnecessarily either. A good doctor should always ask about and value your preferences and wishes. Completing an advanced directive helps codify what you want. However, sometimes your mind changes when you become more severely ill. Frequently, either the patient, or a family member of the patient, wants much more done in terms of testing and treatments than we think will be helpful. This can decrease quality of life, and as you mention be costly. I would hope that you don't come across physicians who have a financial motive for futile care.
28
@Jack Having seen my parents and other family members lose their quality of life as they aged, I have decided to end it long before I get to that point. I am in my 60's, single, with no children. I have followed a healthy lifestyle (exercise, no red meat, mostly vegetarian diet) since my mid-20's. Even my family members with heart disease have lived well into their 80's, and my grandmother was just weeks short of her 103rd birthday when she dies, but was bedridden. I have decided that I don't want to live that way and will walk into the ocean if I reach my 75th birthday.
9
I read a few of these comments my favorite being the Dr recommending the use of EKGs
but I found it suspicious that these studies were done in Scandinavian countries where the consumption of saturated fats is much higher than here as well as the Mediterranean countries
healthy lifestyles are most effective when begun from lifes inception
2
@larry
I passed a stress test when I had an
80% blocked artery that was already scented- they said the stress test was negative. LOL. Then two weeks later I was in the ICU where a cardiologist wrote “ probable out come death” on my chart while they waited until morning to take me back to the Cath Lab.
3
@old lady cook
"Then two weeks later I was in the ICU where a cardiologist wrote “ probable out come death”
I guess the old saying is true: It just wasn't your time.
Would love to hear why doctors say screening with cardiac MRI is not recommended yet echocardiogram which is notoriously unreliable and nuclear stress test and it’s huge radiation dose, are.
16
@JW Agree. This article should be more clear that the USA health care system is a misnomer. The decision to request or not request certain tests because of profit and the even less frequent thoughtful interpretation of those test results and action based on the tests lie in the hands of insurers.
15
“Eating healthy”........... It seems that there is a lot of debate about what is healthy. Yes, we all know that a plant based diet is optimal but other than that, there is a lot of discussion among cardiologists about the finer points of a healthy diet.
My husband recently had a stent implanted after a heart attack and on the day he was released from the hospital, he asked his cardiologist about food and the answer was “a heart healthy diet - whatever that means.......”. At least, the cardiologist was honest enough to acknowledge that there was debate behind the scenes.
16
Recently retired cardiologist here--took care of many thousands of patients over more than 30 years, did >14,000 heart procedures. What is astonishing to me about this article is that it doesn't even mention the value of EKGs in this situation. Very inexpensive test, no radiation, no risk to the patient (other than if misinterpreted or if results are mismanaged), and capable of detecting silent heart attacks in many people. EKGs don't have the sensitivity or specificity of echos, CT, and MRIs (they can certainly miss some heart attacks or be read as showing heart attack when there isn't one), but they do a pretty good job of picking them up, cost next to nothing, and are available in almost every medical clinic. Because of the excessive use of screening tests in the past, the pendulum has swung far in the other direction away from doing screening tests these days mostly for good reasons. However, it strikes me that it might be a good idea to get an occasional EKG in patients with increased cardiac risk factors.
79
@Heart Doc I had 100% blocked lad and a normal EKG. I wonder if you wanted screening for yourself if “pretty good” would be good enough.
6
@Heart Doc
Dear Heart Doc, thanks for the comments. I suggested the Times hire a cardiologist to write these articles. Misinformation is worse than no information- I am a cardiac patient (CAD) four stents at age 59. Now age 69. The technology is amazing if the right doctor is on the case.
4
Since the age distribution in the study was between 67 and 93 one might assume that the median age was in the late 70s. Therefore after 10 years the median age would be in the late 80s. Since the life expectancy in Iceland and Finland is about 82 years one would expect that by the late 80s more than half the people would have died. Therefore without listing the % of the people that did not having an S.M.I. that had also died the statement that “half the participants with silent heart attacks had died,” is meaningless.
35
The article implies that people with SMI are particularly likely to die while exercising, while also asserting that exercise is beneficial. Both statements cannot be true.
22
@Paul Adams I can't see any reason why both statements can't be true.
Exercise is obviously good, but will not rule out a heart attack and might induce one. That makes perfect sense. Think about it some more.
3
@Paul Adams Exercise is good in moderation. There are people who overexercise. Not me.
4
@Paul Adams Yes I noted that too. In the study from Finland it states that the SMI individuals were unaware of their disease and "presumably did not limit their physical exertion..." Sounds vague to me.
2
After years of including family history on medical charts, I finally asked what I should do if three generations of my family had heart disease since no doctor had. I had no risks. I saw a female cardiologist at Duke University, who ordered a heart scan. To my great relief, it was normal. My doctor had mistakenly wanted a stress test.
3
We have known about prevention of heart disease for decades. So why is it that McDonald's is still in business? Not only in business, but thriving and taking their artery blocking food across the globe.
12
It’s a free country. No one is forced to eat at McDonalds. Plus, you can get an unhealthy meal at a 5 star restaurant - the food may taste better but the heart doesn’t care about flavor....
41
@Concerned Citizen
The ACA was structured based on everyone in the system with good health coverage. But healthier people are choosing not to join which leaves sicker people in the system. Insurers raise premiums and deductibles to protect their profit margin. Also the differential between older and younger people’s premiums is limited by ACA. Before the ACA insurers could charge older people anything, with no limitations. IF everyone is covered and receiving screening and preventative care that would, long term reduce overall healthcare costs. But the republicans have successfully weakened the provisions and are trying to bring back the old system and costs will soar while coverage will be more limited with pre-existing conditions no longer covered. We need universal health care not tied to employment. Period. Anything else won’t work and will cost more.
66
I try to live healthy, but not too healthy, coz I'd love to have a big, all ending, Holywood style attack at the age of 85, or at least well before all the other debilitating precursors of the Great Reaper get hold of me.
36
My high deductible policy with exorbitant copays and hidden out of network costs, means that my episode of heartburn and fatigue, will cost five grand out of pocket if I present to an ER. That MI isn’t “silent”, just too expensive to investigate.
134
This article perpetuates the misconception that women present with "atypical" symptoms, therefore making it harder to diagnose women. Research published in the 8/21/2019 Journal of American Heart Association reports that women are MORE LIKELY than men to experience the #1 symptom of a heart attack, chest pain. Maybe we're not listening...
29
@nursepractitioner “women more likely than men experience chest pain” does not mean that women do not experience vague symptoms more likely than men do.
Anyone who walks into the ED with chest pain will make me put MI high on my differential. However, doctors “perpetuate” the vague symptoms HPI because it’ll now remind me that if a woman is complaining of epigastric pain, don’t simply think it’s only GI related, but that an MI in a woman presents as vague symptoms many times too. Perpetuating that will certainly save a life :)
17
@nursepractitioner My father had the "vague symptoms" similar to those females are likely to experience with a heart attack, and it took several visits to the ER before they finally took him back to the cath lab and wound up stenting him. He did not have the classic chest and left arm pain, so they didn't believe he was having a heart attack. The cardiologists misdiagnose those vague symptoms even in men.
3
Die of a heart attack after a life of "good" living, or of cancer or dementia a few years later....assuming nature or other humans don't get you first.
36
There is very little actionable information in this article.
Another in a long series of NYT “health”articles” that attempt to explain a scientific study but leave the reader with unhelpful, confusing,
and/or wrong information.
If the NYT still has editors they should have asked the writer: is this news? What difference does it make? What is the takeaway? What can our readers do with this “information”?
114
@Space Needle An article that provides good information doesn't have to be actionable to be useful. It might lead you to ask a question that leads somewhere. For example, if it is the case that cardiac MRIs are much better than EKGs at detecting S.M.I. but MRIs are too expensive to be used for routine screening then one might ask is there a way that the MRI process could be made significantly less expensive. A little bit of thought suggests to me that the answer is unequivocally yes. Example: a company that specializes in standalone MRIs could negotiate steep discount pricing from the manufacturers (Siemens, GE and Phillips). Hospitals have siting issues that can incur significant renovation costs while a specialized standalone operator that builds a standardized building does not. Operations can be streamlined with scans run 24/7 with only occasional downtime for maintenance. Etc.
Your lack of actionable items could be someone else's opportunity!
9
@Space Needle Readers can enlighten themselves and extrapolate from this article information that may lead to better health. Knowledge is power. It's a newspaper, not a scientific journal.
7
Something else I'm supposed to be afraid of.
28
According to the SHAPE (society for heart attack prevention education) task force of cardiologists, there already exists a noninvasive test to determine the calcium plaque buildup in your coronary arteries. The coronary artery calcium test is a CT scan that costs about $200.
Check it out: https://www.sciencedirect.com/science/article/pii/S2211335519300592?via=ihub
http://shapesociety.org/
10
@Robert Steffes I had a coronary calcium scan in 2010, which showed blockage in the descending aorta to the 99th percentile. I am yet asymptomatic, and two nuclear stress tests were negative. So what do It do? I take a baby aspirin and a statin (although my cholesterol levels have always been normal). I believe that the test was accurate, but I also believe that all the running I did for 30 years created corollary circulation.
12
CT scans are high in radiation exposure.
4
@Robert Steffes I just had this done and it cost $75.
I have no idea why it isn't covered but at least it wasn't so costly.
3
Geez Louise, something else to worry about!
15
I think I have had a 'silent heart attack'. I left the incredibly stressful job that brought it on, and they screwed up my COBRA. I have no health insurance now.
As a full time grad student, I am keeping tight control over my spending (paid off house and car, don't have any debt, so it is not that hard) and living off my savings for a year.
Going to the health department in my state isn't a practical option. I can't afford to get tested in a doctor's office or clinic. Healthy lifestyle is my only option for this year. I can't afford Obamacare since they look at the salary I am no longer making.
My plan/hope is to truly be healthy over the next 10 months as I finish my degree and find work. Like many Americans, this is a reality. I've only been insured for 12 years of my 40+ years of working.
60
@Josie You can get health insurance even though you are not working through Obamacare. You should not have premiums and low office visit copays.
7
@Josie If you are still a New York resident, there are medical plans which you can still access. NY expanded Medicaid, and if you qualify by income, the state does not look at your assets, but only your income, if you are under 65.
There are also plans for NY residents who earn a bit too much to qualify for Medicaid. https://www.health.ny.gov/
My son, a recent college grad, not earning much, was able to access a decent medical plan, through the NYS healthcare website.
If you are a Florida resident, forget about it. Florida did not expand Medicaid, and wants you to die quickly if you become ill.
7
This is an excellent review and advice.
But if your doctor even bothers to do an ECG prior to surgery, and a silent MI is seen, don't expect to get your surgery delayed for a cardiac workup.
Two years ago I testified as an expert witness in a post op death case. The patient had a silent MI pre op, and had uncontrolled hypertension, diabetes, obesity, and cholesterol. He had no cardiac workup and died a day after elective back surgery.
An autopsy showed the silent MI and a 90% blockage of his proximal Left Anterior Descending coronary artery in the "widow maker" position.
The defense brought in 3 professors from big name medical schools to say that the surgeon and anesthesiologists followed the guidelines in not getting a cardiac workup pre-op and the experienced pathologist medical examiner must have missed a pulmonary embolus (blood clot) which must have killed him.
No negligence. The jury agreed.
These insights don't go very far in Texas with Rick Perry's tort reform in place and medical school professors and top medical journal editors adopting a "less is more" attitude toward all cardiac testing.
Yes, I am aware of the few small randomized trials that were used to make the pre-op testing guidelines and this man would not have qualified for those trials.
So, if the silent MI doesn't get you, the clinical practice guidelines might. Don' expect your surgeon to buck the guidelines.
47
@Brant Mittler, MD JD
I had a routine pre-op EKG a few years ago. It showed an Inferior MI, and I had no history of heart disease. I was referred to a cardiologist who did an echocardiogram and found no abnormality in cardiac anatomy or function. My Medicare paid for it, and I was cleared for surgery. This should be standard of care.
20
Ms. Brody writes: “Even without medication, if everyone at increased coronary risk adhered to a heart-healthy lifestyle, “the incidence of heart disease would be reduced by 80 percent,” Dr. Rekha Mankad, cardiologist and director of the Women’s Heart Center at the Mayo Clinic in Rochester, Minn., told me.”
Since this risk reduction is similar for other lifestyle diseases and/or conditions (type 2 diabetes, kidney disease, obesity, etc), why don’t we all cut our risks by adopting a healthier lifestyle?
The easiest is to eat a better diet: plant based whole foods is one of the healthiest, if not the healthiest. Veggies and fruits, whole grains and beans, and in moderation nuts and seeds. Avoid processed food and animal products.
Then, don’t smoke or drink alcohol, and exercise.
These would all make a huge difference.
27
I have celiac disease and related digestive issues. Lean meat is an important part of my diet. Beans and, obviously, gluten-containing grains are now out. I do wish people would not assume everyone should eat a vegan leaning diet.
44
Its almost criminal that mainstream news and doctors continue to ignore and not report on and highlight the fact that a plant based diet has been shown to not only prevent but REVERSE heart disease. And in fact Its the only thing, diet, medication or otherwise, that has been shown to do this. At least let people know! Then they can decide for themselves if they want to partake in such a diet or at least eat in a manner that moves towards such a lifestyle.
25
The US obesity epidemic is raging.
Try telling most Americans to adhere to a heart-healthy lifestyle.
22
Ayurveda, the traditional Indian system of medicine holds several beneficial guidelines for the healthy heart. It recommends spices, herbs, and other nutrients to be taken in small and daily doses. Ayurveda aims to maintain the health of an individual through lifestyle changes that include behavioral, diet and nutrition and drugs. The inability of the present-day population to follow these lifestyles that put them at high risk for heart diseases.
Ayurveda place great importance to the bark of a botanical tree called Arjuna (Terminalia arjuna). Arjuna bark’ s benefits as being heart healthy, improving blood quality, preventing and removing swelling and clogging apart from promoting other cardiac functions.
It's rich in potassium (24 %) which is good for the heart, in addition to arjungenin, arjunolic acid, polyphenols and gallates. Its cardio-tonic activity, which strengthens the heart muscles, is also described in many ayurvedic books.
Studies have shown that Arjuna bark extracts are useful to treat heart disorders like chronic stable angina.
Studies on Arjuna have also demonstrated high antioxidant activity, besides promoting nitrite oxide formation in the walls of blood vessels, which give necessary elasticity to the arteries, preventing hardening.
Food with its mix of spices and herbs is in itself good for healthy heart.
Modern lifestyles and work pressure take their toll on our lives Arjuna and spices in our food can play a vital part in healthy heart.
23
Jane, "followed for up to more than 13 years" is a totally uninformative phrase, encompassing anything from zero to infinity. The original paper stated "followed for up to 13.3 years", which not only uses fewer characters than your version, but also means something.
Your articles are typically so informative that we expect better from you!
6
How many people that experience the symptoms described in this article that may or may not be experiencing a silent heart attack do not seek immediate medical attention due to (1) not having medical insurance and/or (2) having medical insurance with high-deductible requirements? Many American's cannot afford a visit to their local hospital and may avoid going even if they THINK that they might not be having heart attack. This is the sad and disgraceful state of medical care in America.
64
@M.A.: agree, money and insurance costs matter. I’ve avoided getting checked when I’ve had symptoms, weighing in the cost factor and waiting it out. The system is broken.
4
Only one comment thus far has spoken to the fact that heart "attacks" --and heart failure--are demonstrably under diagnosed in women. There are many respectable studies of this, and I am amazed Brody didn't point to those studies. As a survivor of gender bias in heart care, all I have is an anecdote to offer, but I hope it matters to someone out there.
In the fall of 2008, I was having increasing trouble breathing and suffered from no energy. While it was true I was under enormous stress, *none* of the doctors I consulted in the city where I worked did more than attribute the symptoms to more than "extreme stress/anxiety/panic attacks."
I was fortunate enough to see my long-term female internist over a break, who for the first time in my life ordered an EKG. After that, she sent me to a superb cardiologist. As I had passed a "stress test" and echo with flying colors 4 years before, I knew I was in trouble when I heard staff say "no stress."
I am very grateful to the female doctor who believed me and referred me for saving my life--and I am also grateful to the superb male cardiologist who saved me by telling me we couldn't wait to have a pacemaker implanted.
There is a Japanese word--Takosubo--for "broken heart syndrome" I am alive and kicking best I can thanks to docs who stopped labeling me as an hysterical female.
71
@Lynne N. Henderson Not sure what you mean by "I knew I was in trouble when I heard staff say 'no stress.'" What are you saying?
11
@Bill
My guess: They didn't want her taking an actual, treadmill-type stress test which would place more load on heart without being able to as quickly reverse a bad situation should it develop in course of testing.
One can have a 'resting stress test' where they control factors via meds administered to speed up heart, slow it, etc.
They were recategorizing her as higher risk based on her oral history and/or exam ... again, just my thoughts.
Hopefully, Ms. Henderson will check in again and let us all know if this is indeed what was meant.
Good health to all.
13
@Lynne N. Henderson I don't follow what "no stress" meant and what your diagnosis and treatment were.
3
I can't tell you how many years I have been told to get a mammogram, which I dutifully did.
Then, on my own, I took advantage of an offering by my health care system to get a cardiac calcium CT scan for $40. I spent the money thinking I would have just one more health issue crossed off the list. The results showed that I have severely blocked coronary arteries and a nascent aortic aneurysm. Funny thing: all the usual tests showed that I was fine. Now, I am under the care of a good cardiologist and we take this very seriously.
The scales are out of balance. Women die of heart disease at a much higher rate than breast cancer, yet the mammogram industry keeps us coming back annually to be tested while we ignore the possibility of structural heart issues.
268
@Karen Dumont Your are right! All these mammograms! I think I could benefit from the cardiac CAT more than these annual mammograms. What was your treatment?
9
@Karen Dumont
I'm a breast cancer survivor who looks with dubiousness at NFL players and baby cheerleaders wearing pink in October. Breast cancer is way down the list of what kills women, after heart disease, stroke, Parkinson's, lung cancer, and more. Also it's way less lethal than pancreatic and other cancers. But everyone likes breasts at some point in their life, and nobody cares about a pancreas until they know what it does. And hearts are taken for granted as they are beating every time we check them, until they aren't. So breast cancer gets the money.
17
Brilliant comment and I am so very glad that you are being treated and hopefully will live a longer healthier life.
Sudden Cardiac Death among younger people are far more common than we know, someone needs to care and look
4
What no one has mentioned is that the test subjects were 67-93 years old when the study started. Ten years later they would have been 77-103! We are supposed to die at those ages, and our healthcare INDUSTRY cannot prevent our deaths! For me, it’s bring on a heart attack early rather than the Alzheimer’s that took my mother’s life later.
48
@Liz Why say that no one has mentioned that test subjects were 67-83 years old? It is clearly stated in the article. Why repeat something that is so clear? The abolute times of death are not important. The point is to compare death rates among those with S.M.I., those with recognized heart attacks, and those with no heart attacks.
Few would want to die of Alzheimer's disease but few would want to die of a heart attack when they are otherwise healthy (as my brother did). Are you suggesting that heart attacks cannot or should not be prevented? If not, what are you saying?
8
@Bill Hi Bill , I meant that none of the reader responses to Ms. Brody’s article had discussed the age of the test subjects that she reported on. All were senior citizens, and some quite old. To have those test subjects die within the ten year period of the study does not seem to be a significant finding to me.
And what I am saying for myself is, yes, I would rather not look long and hard for heart problems, when that is the body’s natural way dying. After comparing my mother death from Alzheimer’s and the heart attack that took my father’s life, my preference would be a heart attack.
7
Unfortunately many of the people who most need this kind of health advice are virtually powerless to take it ... because the U.S. healthcare/coverage system leaves them unable to afford preventive care.
52
Not true. Most “preventive care” is FREE, and the advice is available for free also through various services, this article being an excellent example. Exercise, walking for example, is free and even cheaper than driving. Stopping smoking is free ( not always easy but doable ) and you will save the cost of a pack of cigarettes, maybe $10-15 per day for some folks ( that’s $3000-5000 per year). Weight loss is free and eating fewer calories each day and every day to achieve a healthy weight can save you money at the grocery store and restaurants where portions are huge and loaded with salt and fat. High blood pressure and high cholesterol are both benefitted, and maybe even cured, with healthier diets. If family members have cardiovascular disease, then assume you are at risk and starting now, if you are not engaging in free preventive lifestyle measures, then begin. It’s free and even money-making for you and means YOU are doing what you can do to prevent serious and life threatening disease.
What every person reading this article should also become doing is asking themselves what they themselves are actually doing every day to take care of themselves. You are worth your best care of your self. You don’t need a test to tell you that.
32
@Lolly Schiffman
Prevention, preventive self-care, and preventive healthcare are three different things.
But while everybody can afford most or all elements of the first two, it's not true that everybody can afford preventive healthcare, to which my comment referred.
One of the problems of our patchwork healthcare/coverage system is the extreme variability of both coverage and care. It depends on age, employment status, income, state, type of population area, and sometimes county, assets, which political party controls a state, time of year (if there's a waiting list) and probably other factors.
18
Just one more case in point -
We get regularly screened for breast, colon, and prostate cancer, but doctors do not recommend normal routine screening for heart disease or blockages that are not bad enough to cause symptoms.
Because I have a family history of heart disease, I would welcome the change to annually, have my heart and carotid artery evaluated for plaque, and if there are any problems, have them taken care of before I have a heart attack or stroke.
My approach to heart disease is no different than a woman whose mother died of breast cancer - I want to know before its too late, I want to know when it can be stopped, before blockages are only 25-30%, before the first TIA.
But, unfortunately this is not part of routine health care in the United States.
77
@organic farmer I agree completely. When my brother died of a heart attack, he had had no symptoms. He underwent physical exams every year but the blockage in three of his arteries went undetected. There is a strong history of heart disease in my family but insurance does not cover testing to find out if I have blockage as well.
Annual testing for cancers but not heart disease seems utterly irrational, especially for those at high risk.
25
@organic farmer
Even worse, my sister's doctor told her that she didn't have to worry about heart disease because she is taking statins. No other tests needed.
Yikes!! This is the state of our health care here.
23
I recently survived an MI that took me a few days to find out about. I felt dizzy and had some back pain but no chest pain or arm or many of the other more highlighted symptoms. I've been a long time runner, healthy vegetarian, non smoker etc... all the right things. My 100% blocked LAD (aka widow maker) didn't kill me because I had developed collateral blood vessels over the years. What did I do wrong? Picked the wrong family, heart disease runs rampant in both sides there was no escape and my physicians and I should've tested more regularly in my circumstance. 5 pass CABG and I'm fine, but so close. There are many symptoms, many causes.
83
I had a colleague, in his mid-fifties, who was skittish about an upcoming hip replacement. I told him not to worry because the surgery was at one of the world’s best universities, a facility in the top five in cardiac care in the US. A pre-op electrocardiograph showed no problems. He died during the procedure despite heroic efforts to save him. A postmortem showed blocked arteries that would have been easily detected by other more revealing methods. But those methods are not standard practice and therefore no covered by insurance. Months later another colleague, scheduled for orthopedic surgery, insisted on an angiogram before the operation even though the EKG was normal. The angiogram showed two of three cardiac arteries significantly blocked. His life was probably saved by the unfortunate death of his friend.
225
"In the United States, a heart attack is the leading cause of sudden death in people 65 and older.”
Hmmm. My brother was only 63 when he died of a heart attack. He was always thin, always moving and working and supposedly in great health, ate extremely sensibly too. But then that morning he took his best pal, his dog, outside in the back yard to do his morning thing. When my sister-in-law found them, the dog was laying on my brother's chest, refusing to leave. He was gone from this world before he ever hit the ground.
I've experienced any number of these symptoms "mild chest discomfort, heartburn, nausea, shortness of breath" on any given day, especially within the past few months. I've mentioned this to my doctor and he is well aware of my brother, but having having an EKG in the office, those results showed nothing abnormal . . . and yet the symptoms persist.
Perhaps it's time to see a different doctor after all I'm in that age range and those symptoms are not lessening.
185
See a different doctor. An “EKG in the office” is the wrong test. A treadmill or stress echocardiogram is a test that determines what happens when your heart works harder, needs more oxygen delivery but may not be getting more blood flow and oxygen delivery due to blocked arteries. If nothing else, tell your doctor this.
30
Follow your gut and get a second opinion. I am alive today because I did.
27
@Marge Keller get thee to a cardiologist pronto
27
My recent ancestors all lived in rural Oregon where they weren't exposed to toxic chemicals in the air and water and "suffered" only from unremitting physical labor. Some of the ladies lived past 100 in good condition and many men and women lived into their 90s, even though all the men smoked (but none drank because their religion forbade it). They had no money for doctors which killed a few in their early years but didn't stop most from staying healthy and getting old. I think most people underestimate how long they can live a healthy life if they just avoid all the known pitfalls of smoking, drinking, overeating, and sloth and then have just a bit of luck.
33
Upshot of this informative column is:
1. You had a silent heart attack in the past but there is no affordable practical test to detect it.
2. You didn't have a silent heart attack but you have no way of finding it out.
In either case the best option is to follow a heart healthy lifestyle.
It is that simple!
160
@Jaque This was my thought exactly. I have been a practicing physician for nearly 40 years. Prevention is the solution to many of our health care issues.
37
@Jaque How will suddenly starting to "follow a heart healthy lifestyle" prevent a person who's already had one or more silent heart attacks from dying of heart failure?
It is absolutely not that simple.
Changes in the US health insurance system are desperately needed so people who are unknowingly at high risk can have life-saving bypass surgery!
21
The variety of symptoms makes it very hard for a primary care MD to send a patient for cardiac MRI or CT. Everyone with a headache can’t get an MRI without bankrupting the system. So more astute screening and histories are as crucial as healthy lifestyles. Genetic vulnerability coexists with great diet & exercise.
11
Very difficult to understand that 17% of patients initially screened had evidence for S.M.I even allowing for entry criteria of at least 67 years. Unless we know other entry criteria ie diabetes family history HTA SMOKING this study cannot properly be assessed and will likely lead to much useless testing in low risk patients
9
Aunt Gert lived another 20 years (into her 90s I think?). I hope she had great quality of life at that age. Few will.
I would rather die in my sleep than of a massive painful heart attack but put me on the list of those in favor of sudden death at a ripe age, when I'm still enjoying true quality of life--eating, sleeping, thinking straight, able to walk a mile or so.
135
You may think that way now but when you get there you’ll value every breath you take.
12
@Charlotte K
Focus on this: almost no one dies, quickly and gently, in his/her sleep, without ever suffering the assaults of some disease or loss of faculties, whether in acute or chronic form. Actually, no one I have ever known has. There have been fatal injuries from car crashes, cancer in multiple forms, dementia and decline by way of osteoporosis and catastrophic fractures, vascular dementia, overdose, a severe subdural hematoma, COPD, and a bowel obstruction.... Some situations make a massive heart attack look preferable.
If you want to exit this life painlessly while you're still enjoying things, you have to take it into your own hands -- but again, who would want to do that if they weren't in pain?
8
Everyone should "adopt medical and lifestyle measures that can minimize cardiac risk, like normalizing blood pressure and cholesterol levels, quitting smoking, losing weight if you’re overweight, getting regular exercise and controlling Type 2 diabetes" even if one hasn't had a silent heart attack. No need to wait until you have heart damage, silent or otherwise! Perhaps the article could have discussed what measures are taken for people with silent heart disease other than what we should all be doing anyway.
65
The leading cause of sudden death is not a heart attack, as stated in this article, but cardiac arrest. Cardiac arrest is an “electrical” problem with the heart while a heart attack is a “plumbing problem.” Heart attacks can trigger cardiac arrest.
105
@Richard -
“Cardiac arrest” and your “sudden death” (or more accurately, “sudden cardiac death”) are essentially the same thing. Your heart stops beating, yes, an electrical problem. The causal biological question is: what caused the electrical problem, what caused the heart to stop beating?
While it could be a number of things, indeed, the most common is a “heat attack.” I.e. a thrombus (blood clot) forms at a break in the inner lining of a coronary artery, blocking blood and it’s oxygen from feeding the heart, causing some of the heart muscle to die. If it is enough of the wrong muscle, that disrupts the heart’s electrical system enough to stop beating.
Other things can cause SCD, but traditional heart attacks are, quantitatively, the most frequent cause.
And we have to get away from the old, deceptive, “plumbing” model of thinking about cardiovascular disease. The newer “vulnerable plaque” model is better, but an “endothelial health” model is best of all.
12
If it were possible to do so, I'd opt to die quickly of heart failure, silent or otherwise, with my boots on, preferably while working in the great outdoors.
Better than lingering in a nursing home so Medicare can claw back the home we've worked so hard to keep as a legacy for our son and grandchildren.
293
@Marcia MacInnis I agree with you. I had a MI a few years ago. A total surprise. As I waited for the EMS crew I felt my life slipping away. The impending feeling of doom gave way to a peaceful feeling that I was letting go. I felt happy, actually. I'm glad my life was saved and I am enjoying it even more. The dying paradox is confusing. I'd like to live as long as I can and just keel over when the time comes. As Woody Allen said, " I don't mind dying. I just don't want to be there".
120
@Marcia MacInnis ~
"Better than lingering in a nursing home so Medicare can claw back the home we've worked so hard to keep as a legacy for our son and grandchildren."
Is there any way you can put your home in trust for your children?
The idea of spending my last days in a nursing home would be a living nightmare.
44
@Marcia MacInnis
Heart failure can be a slow, painful process. I watched my dad suffer from heart failure over the course of 25 years. I wouldn't wish his last six months of life on anybody.
32
Good article but we need to know more since "Screening large groups of people for evidence of an S.M.I. is not economically or practically feasible at this time." I'm sure the E.R. departments do not want to see every individual who fears they may be having a silent heart attack. Many E.R. simply could not handle the extra load. We need to know more so we can determine whether or not we are at risk and get a better handle on whether or not we should be heading to the hospital. And what about taking a 5mg Aspirin immediately? Would that be a good idea?
19
@Ken Wightman
"... taking a 5mg aspirin immediately?" Actually, that would be either a "baby aspirin" at 81 mg or a full-strength aspirin at 325 mg.
18
@DH Thank you. You're correct as to strength. I should have typed 81 mg. I must take one a day for my heart. But these are no longer referred to as "baby aspirin" because children are no longer given aspirin because of connection to Reyes syndrome. The link between aspirin, even low-dose aspirin, and children needs to be broken.
8
@Ken Wightman My doctor specifically told me to start taking a "baby" aspirin daily, but when I went to my pharmacy I couldn't find any. The pharmacist had to explain to me that no one sells "baby" aspirin anymore.
5
“Women, whose symptoms are often vague, are especially unlikely to realize they are having a heart attack.”
The above sentence needs a reality check.
Here it is corrected:
Women, whose symptoms are often vague, are especially likely to realize their symptoms will be diagnosed as panic, stress, and anxiety.
519
@Laume I spent 30 years as an ER physician. I don’t think I or any of my colleagues jumped to a diagnosis of panic or anxiety without a comprehensive evaluation. Cardiac symptoms can cause stress and anxiety. I can recall several instances over the years when a patient came in (or was sent in from a care facility) with a presenting complaint of “anxiety attack “, but ultimately diagnosed with cardiac ischemia or MI. I think it would be very unusual for any ER doctor to disregard the possibility of more serious issues in a patient presenting with anxiety, unless the patient was a frequent visitor with a prior benign evaluation.
21
@Laume
Or depression.
Be taking -- prescribed -- ANY type of anxiety med, and you will be totally dismissed by all staff at an ER or elsewhere, from the first nurse you see to the lone physician who might wander by distractedly.
All make up their minds immediately -- 'head case.'
23
@Laume Three times over the last five years, I've experienced an esophageal spasm, sending me to the ER. Each time, they've done tests to determine if it's a heart attack (which it hasn't been). Until now, I thought the testing was ridiculous -- but since they only thing that eases it has been nitroglycerin, I guess it's not so ridiculous after all. After the third time, I started carrying nitro with me; thankfully, I've never had to use it.
16
Mortality is intrinsic to our being mortal. I suppose that each of us would not wish to have a long, drawn out demise, especially if that demise was being caused by a disease the treatment of which causes us a sickening and long-suffering existence. When my grandmother was 99 years-old, or maybe a year or two earlier, she would tell people that she wanted to live to be 100 years plus 20 days. When asked about the 20 days, she would say with a wonderful sparkle in her blue eyes: "I don't want to die suddenly!" My Bubba finally did pass "suddenly"; on the day before her 106th birthday.
57
Let's not forget that sudden death is the goal. We don't want to survive so that we can experience a long slow mental or physical decline. It's surprising how few writers on medical topics have grasped this.
315
@KLTG I have cared for plenty of people - men and women - who had silent MIs in their 40s or 50s. Sudden death may be our long term goal, but for many it's nice - and possible - to put it off for awhile.
33
@KLTG The goal is to die in your sleep in your early 100s without ever suffering any mental or physical decline significant enough to cause you any distress. It's not to die at 55 or even 75 after a few hours of agony from a heart attack.
44
I think you may have confused sudden death at a much older age, which is better than slow deterioration or dementia, with Sudden Cardiac Death, which happens to much younger people, 20s, 30s, and middle aged, or younger seniors.
SCD has no warning at all, no signs from screening tests, or obvious symptoms. It's often from an arrhythmia that was not found and treated earlier, or it's a silent fatal heart attack from blocked arteries that were never found and cleared in time. It is often genetic, rarely connected to anything modifiable by lifestyle, and very tragic for the families.
5
A very useful article and I have a family history of heart disease going back 4 generations so I have regular checks as does my sister but she was taken to hospital at the weekend with a suspected heart attack. She had all the signs they say women get - strong pain across the back then down the left arm etc. However after many tests 36 hrs later they released her & said there was no attack. That was the same day I was having a Carotid artery Doppler scan as part of my prevention plan.
However regarding congestive heart failure deaths; my tiny mother lived with severe CHF for 20 years (on 10-11 fluid tablets per day for her last 3 yrs) and her sister had the same problem for the same amount of time before her death. So it comes down to early diagnosis.
16
@Carole: Sounds like your sister may have been misdiagnosed. Women presenting with heart attack symptoms are so frequently told, essentially, that it's 'all in their head'.
6
I wonder how people with no insurance or inadequate insurance can possibly afford all the testing recommended in this article. It is fine to have tests when you have Medicare but even then you have co pays that you may not be able to afford. This is the state of healthcare in the United States.
302
@Lily Quinones Exactly! When I showed the nice lady at Morton Plant my insurance (Medicare plus Supp. F) which costs us about $500 a month she gushed that it was "the best. You'll never have to pay anything here with that." But I still have to pay $140 for a nuclear next week. Note to Senator Warren: Please raise our taxes by $5000 a year to pay for Medicare for All or Single Payer. My wife and I will come out ahead by about $2000
188
@Lily Quinones Agreed. I'm on Medicare, have normal BP, low weight and exercise, but I think I had a heart attack 5 years ago and told my Dr. She thinks I'm healthy so would not order the tests I need. My dad died of Congestive Heart Failure, my mother of complications of stroke and my brother just died of a heart attack. Even if I pay out of pocket, I can't get the tests I feel that I need. Don't tell me to switch Drs. There are few taking new patients.
68
@Concerned Citizen,
The ACA is the result of COMPROMISE! So, thank the republicans who gutted the original plan proposed by the democrats. As well as Big Med, Big Pharma, and Big Insure, who lobbied against it. And why? Because they profit mightily off illness in this country, as well as expensive but woefully paltry “health insurance” plans. And then support politicians who support their business plans.
I consider the health insurance that you have as “catastrophic health insurance.” It’s what I had at age 63, purchased on the private market. When I was diagnosed with breast cancer. So, yes, I did pay about $14,000 in premiums and deductibles that year. But it wasn’t nearly what my total treatment cost. So I still came out ahead.
But if you want comprehensive health care for all, look carefully at what democratic candidates are proposing, and vote for the ones who’s proposals you like the best. And write to your representatives about what you want. Writing to readers at nytimes.com is not nearly effective as voting and writing to your federal (and state) reps.
103
Didn't know I had a heart attack until I went to the doctor to prep for an Abdominal Aortic Aneurysm operation when I was seventy-five. I never had any symptoms that I can put my finger on but there were signs of damage; now eighty-four.
37
@Concerned Citizen,
I think that one solution was recommended: Adopt a healthy or healthier lifestyle. Improve your diet (plant based whole foods can’t be beat), don’t drink alcohol or smoke tobacco, exercise. These can all reduce risk of a heart attack by about 80%, according to the article. Though the risk doesn’t go to zero. But 80% is a BIG risk reduction.
17
@Concerned Citizen, exactly - if you have NO symptoms and no indicators of risk, what do you do? Doctors will not order those tests if you have no symptoms or risk factors.
Some insurance plans will cover annual ECGs, but not all, and those won't detect everything.
10
@lclav
But congratulations - they got the aneurysm! Just as scary, even more deadly!
I had a heart attack that damaged my heart but I didn't think I had had one. I had chest pains but thought it was winter asthma. It was extremely cold weather and it was only walking the dog outside in the cold that I suffered pain. My GP was sure my pain was heart related and tests showed that I had had a heart attack. I was stunned. So take those symptoms seriously. I now take pills. I have no plaque and eat a good diet, it was caused by radiation for cancer that damaged an artery.
58
@getGar,
That is scary. Radiation is indeed one cause of heart damage. I never thought that one outcome could be a heart attack; for some reason, the risk of “heart damage” when undergoing radiation “therapy” (which I now wish I’d never done, the benefit is so small) did not translate into “heart attack” in my mind. I’ll ask my PCP about this.
Thanks for the warning.
16
@Concerned Citizen, again, Obamacare is not "worthless" with high deductibles unless you choose the low-premium high-deductible plan.
However, it's disgraceful that ANYone in this country should have to declare bankruptcy due to medical bills - the most common cause of bankruptcy in the US.
I do question, though, why anyone would choose to go without ANY insurance at all - even someone young and apparently healthy.
40
@Concerned Citizen I think by'winter asthma' the writer means asthma that is triggered by cold air, which is not uncommon - especially if you live in a four-season climate. When winter's cold temperatures hit, it can be a shock to the lungs, which feel like they are constricting - chest pain.
14
My father had a previous unrecognized heart attack. After learning that he did, he thought back and realized it was when he was roto-tilling in the backyard. He felt nauseous. So he stopped and come inside.
40
@Don Wiss, a very subtle symptom. Who would guess that nausea, on its own, would be a heart attack symptom? I would think it was something I ate.
6
@doy1 The article mentions it:
"A silent heart attack is not always so silent, but its symptoms -- mild chest discomfort, heartburn, nausea, shortness of breath -- happen to lots of people and are typically attributed to other causes and not brought to medical attention,"
Also note shortness of breath. A friend of mine's mother complained of shortness of breath to all her family and friends during the Christmas festivities one year. No one thought much of it. She died of a heart attack shortly afterwards.
9
I find article very useful to avoid sudden death. It's a hidden disease which, as mention people may not knowing that he/she is under death threat. This is more useful to people who are working under stress and threat. If remedial measures taken in time, a person can extend his life span.
18