My Heart Attack in Silence

“Why are you awake?” my wife inquired.

“I think I might be having a heart attack.”

We anticipate heart attacks to happen the way we see them represented in movies or on TV shows: an elderly, heavy-set guy under a lot of stress suddenly clutching his chest and falling, as pulse-pounding music swells in the background. There are ambulances, paramedics, and ER physicians yelling, “Give me 10ccs of Miracle Whip, stat!”

Reality is frequently different. In many circumstances, you may not even notice typical symptoms like discomfort and shortness of breath. Statistics suggest that as many as 45% of heart attacks are "silent,” with minimal overt signs. These are known as silent myocardial infarctions, or SMIs.

Ladies, this may be particularly true for you. Heart disease is the top killer of women in the U.S., and heart attack symptoms for women are typically not as obvious as they are in males. Pain and shortness of breath are frequent for men and women, and a heart attack—particularly an SMI—may show in women as an upset stomach, unexpected exhaustion or weakness, or worry.

I was indeed undergoing a silent heart attack, and I hope what I learned from the experience is beneficial—and may even be a lifesaver—for you.

Whistling past the cemetery

A week ago, I felt a fleeting pain in my chest while jump-starting a car. I was startled and wondered if I might need to attach the jumper cables to myself. The moment passed, but later I double-checked heart attack symptoms: sharp pain in the chest, left arm, neck, or jaw, and possible lightheadedness, shortness of breath, and sweating or clamminess.

Whistling past the graveyard, I concluded that other than the brief pain, I was symptom-free and just fine. Really. Never mind that I’m 66; my BMI (I refer to it as my Big and Mighty Index) is over 30, and my lifestyle is largely sedentary. I also have some extra stress in my life right now.

I went through the week without any other events or anomalies. Last Saturday night, however, I started feeling a mild ache in my inner elbows. Men are especially likely to discount warning signs and attribute these to other causes. Achy elbows are not on the list of heart attack symptoms, so I optimistically thought I’d been sitting in front of my computer too long with my arms bent, reducing circulation. I went to bed thinking all I needed was a good night’s sleep, but heart issues were still in the back of my mind.

When I awoke early Sunday morning, the dull ache had spread through both arms, but it was the kind of discomfort I get when I sleep on one side too long. What got me to sit up was realizing that I couldn’t have been sleeping on both arms. I also felt a certain fullness in my stomach and chest as with indigestion, but there still were no dramatic, painful symptoms or shortness of breath.

As a guy, I didn’t want to admit there might be a problem or overreact if there was. What if I went to the emergency room and the staff checked me out and said, “There’s nothing wrong with you, you big pansy—go home and stop wasting our time?”

Finally, a still, quiet voice inside me convinced me to go to the hospital. Or perhaps I was hearing the distant shouting of my youngest daughter in Finland saying, “Go to the hospital, idiot!” I woke our eldest daughter, who has been staying with us, and said I needed a ride to our nearby hospital, 15 minutes away. As she was getting ready, I put on clothes and underwear that I wouldn’t mind having cut off of me if it suddenly turned into a real emergency.

At the ER, I said the magic words, “possible heart attack," and the staff swung into efficient action, seemingly trained to be calm and cheerful so as not to induce any more stress in the arriving patient. Within minutes, a young woman was sticking leads to my chest for an EKG, while a friendly young man asked me a series of questions that caused me to barely notice as blood was drawn from my arm by another nurse. Someone else inserted an IV with some relaxants and morphine into my left hand.

By the time that was done, my EKG results were already up on the monitor in the exam room, and the ER doctor bopped in with a smile, looked at the screen, and said some things are "concerning," and your blood shows increased levels of troponin T, which is often a chemical marker that you’ve had a heart attack. We’re going to run one more EKG just to be sure. I was given a nitroglycerin pill.

He looked at the screen again and told me, “Yes, you are having a heart attack. The Cath Lab team will be here in two minutes to take you back to the lab. There they will do some more tests and then any number of things ranging from inserting some stents in your arteries to open-heart surgery depending on what they find.”

On cue, four ladies in masks and caps arrived and took positions at the corners of my gurney, then smoothly moved me into the hall. I didn’t want to think about the “open heart” words I’d just heard, so I said something about how chilly it was in the hallway. One of the team members said, “Brace yourself, because it’s even colder in the cath lab.”

“Is it warmer in there than in the morgue?”

“Yes, it is.”

“Then I’m just going to consider that as a positive.”

Two minutes later I was flat on my back in the lab under a large apparatus with the team all around me. While I had mostly undressed during the exam room portion, I still had my underpants on. While I was supposed to stay as still as possible, one of the ladies asked if I could kind of shimmy my underwear off in case the doctor decided to go through my thigh instead of my wrist with the stent catheter.

“Wow, I haven’t heard those words since my Chippendale audition.”

Without further ceremony, they started running the catheter through an artery in my right wrist. I was conscious throughout, and it seemed as if in no time they had placed three stents to reopen my blocked arteries and restore blood flow and oxygen to my heart.

“We’re done!”

“Done? What’s next?”

“You get to go back to a hospital room for observation, but basically, you’re fixed.”

“Fixed? I bet my cat would have gotten a charge from hearing that.”

Give me three stents, give me three stents, mister, or you’ll never see me any more.

I didn’t know what to expect from my diagnosis and treatment, but I was surprised by how smoothly everything had gone. I’ve had dental procedures that were more uncomfortable.

By being alert to the mild symptoms and reacting relatively quickly, my experience seemed little more than an outpatient procedure. I was discharged Monday evening, about 32 hours after entering the ER.

I had a bag of pills (statins, blood thinners, and aspirin) to take with me, a Mediterranean diet menu to follow, and opportunities for rehab and exercise to follow up on. These pills will help keep my arteries open in the future and will likely become part of my life going forward.

I’m grateful, however, that there is a life for me going forward.

Having a silent heart attack increases the risk of having another heart attack, which could be deadly. Be alert to the risk factors for heart disease and symptoms of heart attacks, including the harder-to-detect silent ones. Alertness and quick action are important if you want your heart attack to have as low an impact as mine.

If you think you’re having a silent heart attack, go to the ER. If you think you’ve had an SMI, immediately see your healthcare professional. Imaging tests such as an EKG, ECG, or MRI are the only way to know if you have had a silent heart attack.