Silent But Deadly

Note from a reader named Alexandra a few weeks back (links added by me):

Dear Amy,

Silent heart attacks seem to be in a zone of silence — not nearly enough people know about this in relation to diabetes.

Diabetics have an especially high rate of these painless heart attacks. They may end up with severelyHuman_heart_model_2 damaged hearts and in heart failure without knowing it.  Pre-diabetics may be at risk as well.

I have a personal concern about this topic because my father had Type 2 and he died from heart failure brought on by a series of painless heart attacks. His brother also a diabetic had died suddenly from a heart attack 2 months earlier — after passing his annual physical exam.

Some years ago, I was a juror on a medical malpractice trial. They did not ask us if any of us had diabetes or knew anyone with diabetes. I was sworn in and seated in the box before learning that the plaintiff had type 2 diabetes. He and his wife either did not seek treatment or his physician had failed to educate him about the urgency of the matter. This man ignored his condition, felt fine, and one day was in a car crash.

He was given a chest X ray in the ER and his heart looked abnormal. He was referred to a cardiologist.  Upshot was that he had had a series of painless heart attacks and his heart was so damaged that he was in Grade III heart failure — and the treatment of choice was a heart transplant. This man was only 42.

I try to tell people that if they are diagnosed with either diabetes or prediabetes, they should demand to be evaluated by a cardiologist in case they have begun to develop arteriosclerosis — especially important to do before beginning an exercise program.

Thanks for your blog!

– AK

A great reminder to think on our heart health.  Who saw the recent NY Times feature, “Lessons of Heart Disease, Learned and Ignored“?  Page 3 notes that “Patients with diabetes might have no obvious symptoms at all other than sudden, extreme fatigue. It’s not clear why diabetics often have these so-called silent heart attacks — one hypothesis attributes it to damage diabetes can cause to nerves that carry pain signals.”

The director of coronary care at Brigham & Women’s Hospital, Dr. Elliott Antman, is quoted:  “I say to patients, ‘Be alert to the possibility that you may be short of breath.’  Every day you walk down your driveway to go to your mailbox. If you discover one day that you can only walk halfway there, you are so fatigued that you can’t walk another foot, I want to hear about that. You might be having a heart attack.”

If you don’t believe him, read Alexandra’s plea above again.  Pay attention to your state of being, get a little educated, and insist on that treadmill test!  Better safe than sorry, right?  We’ve already got the diabetes… so let’s try to leave it at that.


5 Responses

  1. Scott
    Scott April 17, 2007 at 7:26 am | | Reply

    I agree completely with the notion that patients with diabetes might have no obvious symptoms at all other than sudden, extreme fatigue, therefore they should try to beware of this to the extent possible. But its worth noting that while both type 1 and type 2 diabetes have elevated risk factors for cardiovascular disease, the risk factors are not the same, just as they do not have the same disease.

    In particular, last year researchers found that cardiodvascular risk models are not predictive for patients with type 1 diabetes because risk models only exist for the general population, and patients with type 2 diabetes. No risk models exist for patients with type 1, and I’d like to see one developed. Since researchers at UC Davis Medical Center in Sacramento, CA last year reported that the cause of cardiovascular inflammation in patients with type 1 diabetes appears to be autoimmunity, not the risk factors often observed in type 2 patients, including hypertension and obesity, we really need to have separate risk models to better predict cardiovascular risk.

    In the interim, I would just note that the comments about less noticable symptoms of a heart attack are very important to consider. Perhaps its time to recommend an annual cardiologist visit, much as we do with seeing an opthamologist each year?

  2. Sarah
    Sarah April 17, 2007 at 8:31 pm | | Reply

    Scott, you hit the nail on the head. If some cases of heart disease in Type 1′s are caused by inflammation (from high blood sugars, oxidative damage AND autoimmunity), as well as autoimmune destruction of the lining of the blood vessels, then there is nothing in place to help Type 1 diabetics battle heart disease.

    Type 1′s are usually thin, have no insulin resistance, and/or have normal blood pressure.

    In Type 1′s BG control is only part of the issue. Also, most Type 1′s can’t get an A1c in the normal range with the current technology, which would help lower their risk.

    People who are at risk for Type 2 or already have it need to clean up their act and make changes. If this guy was only 42, we can *assume* he was overweight, failed to eat right, and didn’t exercise. Possibly he even was a smoker. My apologies if this was not the case. This disease will kill you people, you can only walk around with a bomb for so long before it will explode. I hope he’s making the effort to look after his new heart…

    If not, it should have gone to a healthy teen born with a heart defect….

  3. Sarah
    Sarah April 17, 2007 at 8:34 pm | | Reply

    “He and his wife either did not seek treatment or his physician had failed to educate him about the urgency of the matter. This man ignored his condition, felt fine, and one day was in a car crash.”

    How stupid is that? “This man ignored his condition”. Does he need a babysitter to take him to the doctor? Only in the US would this happen…

  4. DaveTheCompGuy
    DaveTheCompGuy April 18, 2007 at 10:52 pm | | Reply

    Well, another post here hits home for me… I’m currently looking at some issues with heart health too. I’ve known for a while about the silent-heart-attack risk, and twice thought I was having some chest pain so went to an emergency room… only to wait around there for 12 hours then go home again. (They check for an attack by testing for a blood enzyme, two blood tests 12 hours apart.) What I *do* have is a left bundle branch block – a symptom of a problem, but not anything they can pin a diagnosis on. I’ve had an echocardiogram and a stress MIBI test (the treadmill one), and it’s all coming up ok, but the LBBB is still there. Next week I’m going to have a 24 hour Holter monitor – basically an ECG you wear for a day. We’ll see how that goes…

  5. Ben Marshall
    Ben Marshall August 16, 2012 at 11:00 am | | Reply

    I’ve had a close family member who was worried about getting diabetes and found some information on prediabetes. He found a company that does free testing and gives you a risk score to tell if you have prediabetes and what to do to keep it from turning into diabetes.

    Check out:

    That’s where he got he’s score….saved his life.

Leave a Reply