Silent Ischemia (low blood flow status) and Silent Myocardial Infarction (heart attack)
Mrs. M a 68 years old lady was brought to the hospital with complains of weakness since evening. She also felt uneasiness after visiting toilet. On arrival she had no significant symptoms but her family members were worried and wanted her examined by a doctor. She is suffering from diabetes since last eight years. Her clinical evaluation at emergency room was not significant but her ECG revealed minor changes suggestive of some event of heart. On Further evaluation, her biological marker for heart attack (Troponine) was more than the upper limit of normal. She had suffered from a heart attack. She is managed according to standard treatment protocol and her condition is stable.
Do you think it happened overnight? Of course not. The blocks in your arteries takes long time to develop. Once the block reaches to 80%, symptoms starts. But in many people there may be complete absence of symptoms. They suffer from heart attack without symptoms or even worst, they face sudden death. Apart from that there is one more risk, they may not suffer from heart attack but due to continuous low blood flow, their heart cells die gradually over months to years. As a consequence the heart gets dilated losing its pumping function posing risk of early death.
‘Myocardial ischemia’ is severe fall in blood supply to the heart muscles due to blocked arteries of the heart. It causes unusual feelings characterised as heaviness, pressure on chest, belching, abdominal discomfort or vomiting and occasionally resembles muscular pain. This is known as angina in medical term. But a more dangerous entity is no pain at all, known as silent ischemia.
Silent heart attack is objective evidence of death of a part of heart muscles (heart attack) in the absence of symptoms. Despite the lack of symptoms, silent heart attacks are still heart attacks and can have some serious consequences, leaving behind scar tissue, weakening the heart, and increasing the risk for a subsequent, more serious heart attack and even death.
People with diabetes have a prevalence of silent ischemia of about 10% to 20% compared with a rate of 1% to 4% in non-diabetic individuals. Researchers believe this increased risk is due to ‘autonomic neuropathy’ (nerve disease). Diseased nerves cannot transmit pain signals efficiently and reduce patient’s ability to feel pain, including painful symptoms associated with heart attack, making the signs easier to miss.
Silent ischemia may help explain why the disease is usually more advanced when it is diagnosed in people with diabetes.
Studies have shown that up to 16% of participants with type 2 diabetes are also likely to have suffered the silent heart attack. It is a connection that cannot be ignored. If you have been diagnosed with Type 2 diabetes, it is important to understand the risks associated with the condition and to be vigilant in maintaining and monitoring your health.
