QUESTION: I am afraid that my question is a bit confusing, but I assure you I am telling it the way I heard it.
A close friend relates that he has had a heart attack, without pain or suffering, and that after taking all the tests, his doctor is treating him at home, without hospitalization, with medications and diet.
How can this be? Is my friend in any danger?
ANSWER: In order to put everything into perspective, I am going to change the words "heart attack" to "heart condition", for I believe that more closely describes the situation.
It certainly is possible to suffer from a condition known as Silent Myocardial Ischemia, without pain or symptoms, and still be faced with a serious problem that warrants care and treatment.
In this situation the supply of blood, and therefore of oxygen to the heart, is reduced.
It is probable that this is caused by a narrowing or blockage of one or more arteries that bring blood to the heart (coronary arteries), and that the narrowing is due to atherosclerosis.
Atherosclerosis occurs when the walls of the arteries are thickened by fatty deposits in the artery wall. Despite the fact that this lack of oxygen may cause damage to the heart muscle, and that the same condition in many people causes the pain of angina, there are some individuals who do not experience the stabbing pain that normally occurs when the muscles are deprived of oxygen.
When pain is absent, an important clue to the diagnosis is missing, but the condition may be discovered by taking an electrocardiogram while the patient is exercising on a treadmill, or by recording the heart's activity during 24 to 48 hours using a portable monitor called a Holter monitor.
When the tracings are reviewed, the sign of ischemia, or lack of oxygen is detected.
These tests offer some indication of the extent of the problem, and whether or not there has been damage to the muscles.
Depending upon the patient's condition, treatment may consist of medications that help prevent increasing blockage of the arteries, and include a diet to lower blood levels of cholesterol.
A full program will certainly include a weight loss plan (if that is indicated), an exercise program under medical direction, and help to stop a tobacco habit if that is present.
Your friend may be considered lucky, if the condition was caught before heart muscle damage occurred.
He is in no danger from the treatment, only from failure to follow through.
The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.
