Silent heart attack

definition

A silent heart attack is a Heart attack without the typical accompanying symptom of chest pain. A heart attack means that Organ tissue insufficiently oxygenated and other nutrients supplied becomes. The undersupplied cells die as a result.

In the event of a heart attack, it happens in the heart muscles. This death of the cells usually causes a stabbing or pressing pain that is located in the area of ​​the heart. In the case of a silent heart attack, the origin of the disease is the same. However, there is no chest pain. Therefore, the silent heart attack is seldom recognized while it is occurring.

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causes

The development of a silent heart attack usually begins with coronary heart disease or atherosclerosis. Factors such as stress, smoking and lack of exercise can promote and accelerate the process of vascular calcification. In the vessels, especially the coronary arteries that supply the heart muscles with blood, fat is deposited and the vessels calcify.
As a result, there are many bottlenecks in the blood supply and less blood reaches the heart muscles. The continuously working heart muscle cells run out of breath, so to speak, because they lack oxygen and other important nutrients. Likewise, waste materials that arise during cardiac muscle work are not sufficiently removed.

The heart muscle cells die due to the inadequate supply. This usually causes severe chest pain. In the special case of a silent heart attack, this pain does not occur. Most of the time, this is because the pain is not being properly transmitted to the brain. All diseases in which nerve damage occurs can therefore be a cause for the absence of the chest pain symptom and thus for the silent course of a heart attack.

more on the subject Causes of a Heart Attack and Risks of a Heart Attack

Diabetes mellitus

Diabetes mellitus is known as the Blood sugar disease. There are two forms of diabetes mellitus.
Of the Type 1 diabetes typically occurs in adolescence and is caused by the Body does not produce enough insulin. This allows the Sugar not absorbed from food become. Of the Type 2 diabetes occurs at a later age. The body cells have got used to the body's insulin, which causes them to Consume less sugar while maintaining insulin levels and dismantle.

Both forms go with one increased risk of atherosclerosis, i.e. vascular calcifications. Because the sugar is not absorbed into the cells, remains he in the bloodstream. The high sugar levels in the blood damage the blood vessels and the above-mentioned calcifications occur more quickly. Thus the risk of suffering a heart attack is significantly higher.

The high sugar levels do not only damage the blood vessels, they do also destroy nerve tissue. It comes to the so-called diabetic neuropathy. This means that the nerves can transmit less information. So when a heart attack occurs, the pain stimuli from the dying cells are either not passed on to the brain, or less so. Therefore can Diabetics have more frequent silent heart attacks suffer.

Symptoms of a silent heart attack

The classic symptoms of a silent heart attack are comparable to a normal heart attack. The only difference is that the typical symptom of pain in a silent heart attack is absent. Furthermore, signs such as poor resilience and shortness of breath are signs of a silent heart attack. Fatigue, malaise and listlessness are further symptoms. What typically also occurs with a silent heart attack is a feeling of weakness, dizziness and fainting spells. Sweating can also be symptoms of a silent heart attack, as can nausea and vomiting.

Classically, the existing symptoms gradually worsen. Since a silent heart attack leads to injuries and cell breakdown in the area of ​​the heart muscle, cardiac rhythm disturbances can then occur.

Read more on the topic of Heart Attack Signs, Heart Attack Symptoms

diagnosis

As with the diagnosis of any disease, the anamnesis (i.e. the questioning of the patient) is the first step in recognizing the heart attack. The symptoms felt by the patient, such as dizziness, nausea, sweating and fainting spells, play a role here.

If a silent heart attack is suspected, an EKG should be written immediately. Electrodes are attached to various places on the chest wall (sometimes arms and legs) so that the electrical currents in the heart can be measured. In contrast to the normal case, there are special characteristics that the EKG only shows in the event of a heart attack. Blood tests can also be used. An increase in the troponin T value plays a major role here.

Read more about this Diagnosis of a heart attack

blood values

It is a leader in the diagnosis of silent heart attacks in the blood Troponin. There are also other blood values ​​that can also indicate a silent heart attack. Play it Myoglobin and CK-MB an important role.

The Myoglobin is a protein found in muscles. Heart muscle cells die in a silent heart attack. This releases the substances contained in the cells into the blood. Myoglobin is classic especially detectable in the first 4 hours after a heart attack.
CK-MB (Creatine kinase of the type MB) especially in the heart muscle and is also released when its cells die. Especially 3-12 hours after a heart attack it can be detected in the blood.

Troponin test

Troponin is a special enzyme of the heart muscle that is determined in the blood when a silent heart attack is suspected. It can be measured in higher concentrations, especially 3-8 hours after a heart attack. It remains detectable in the blood for up to two weeks after the infarction.

However, the troponin T can also be incorrectly elevated without a heart attack being the cause. This is due to functionally impaired kidneys, which cannot excrete enough troponin, or extreme loads on the skeletal muscles. This is the reason for an increased troponin concentration in the blood, especially in athletes.

Read more on this topic at: Troponin test

EKG

The EKG is a record of the electrical currents in the heart that cause the muscles to work. These currents can be measured using electrodes placed on the skin. Different peaks and waves represent different points in time in the heart's action.

In a silent heart attack, the distance between the S wave and the T wave is typically increased. The heart attack is referred to as a so-called "ST elevation infarction". In addition, the currents between different electrodes are taken during an EKG. Therefore, several lines are recorded at the same time. The differences between the leads can be used to identify which part of the heart has suffered an infarction.

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How can I recognize a silent heart attack myself?

A silent heart attack it is difficult to see for yourself. Mainly, a silent heart attack can be recognized based on the symptoms. In the acute situation, however, it is very difficult to even recognize that a heart attack has just started. The most characteristic symptom of a “normal” heart attack, the sudden onset of sharp chest pain, is not present in a silent heart attack.

Sudden shortness of breath, such as dizziness or Fainting spells can, however, provide evidence of a silent heart attack. Less noticeable symptoms may also indicate that a silent heart attack has occurred. This includes signs like Nausea and vomiting, as well as a sudden sweat.
Typically but silent heart attacks cause no or only very unspecific symptoms, so that many of them are not recognized by the patient himself or herself be noticed much later in routine check-ups.

Therapy of a silent heart attack

The treatment of a silent heart attack consists in the acute situation initially from a Oxygen supply and Upper body elevation. Also be Nitrates under the tongue or directly in the vein given. This expand the vessels and thus lead to a better blood flow to the heart muscle. Then should blood thinners how Aspirin or heparin are given. If necessary, a gift of Beta blockers respectively. Furthermore is a immediate transport to a hospitalwhere cardiac catheters can be performed, is necessary.

At a Cardiac catheter becomes a thin one Wire through a vessel on the arm or in the groin to the heart advanced. Arrived in the heart will Contrast media via the catheter into the coronary arteries given. This contrast agent can be made visible on an image, for example by means of X-rays. Based on the distribution of the contrast agent in the coronary vessels can Recognized bottlenecks become. These will supplied with a stent if necessary.
A stent is a thin, round one Wire meshwhat in that vessel is introduced and this keeps open. Also one bypass Surgery can secure the blood supply to the heart muscle. An additional vessel is sewn to the coronary arteries. This bridges the locked point and thus brings blood with nutrients to the areas behind.

Other pages where you can find more information on these topics Therapy of a heart attack, Implantation of a stent after a heart attack

Duration of a silent heart attack

Kick often unspecific signs like nausea and vomiting already Days to weeks before a silent heart attack but do not allow any conclusions to be drawn about the actual occurrence of the infarction. The suspicion of a silent heart attack is substantiated when some Symptoms suddenly and over a period of more than 5 minutes occur. Persistent signs for up to 30 minutes are possible.

Since the However, silent heart attacks typically do not occur this acute symptoms accompanied is, can be his Duration most of time neither predict nor determine later. The consequences of a silent heart attack, however, remain in the long run unless they are treated medically.

Consequences of a silent heart attack

The consequences of a silent heart attack are mainly caused by damage to the heart muscles. Depending on the size of the infarct, a different number of heart muscle cells are affected. A silent heart attack that affects a larger area can lead to Heart rhythm disorders come. Since the cells die in the affected area and scars appear, the electrical excitationwhich commands the muscles to contract (contract), no longer forwarded become. The individual cells are therefore no longer coordinated together and work independently of one another. Because of this, the heart is exposed to increasingly greater stress, resulting in a Heart failure and one Heart failure (Inability of the heart to pump the necessary amount of blood into the circulation). This is mostly the Efficiency of the heart and thus the person limited. Because the heart can no longer do the additional work that arises during physical exertion. In the long run, a silent heart attack can result in increased stress on the heart shortened life expectancy to lead. In addition increases the Risk of another heart attack.

Please also read our page Consequences of a heart attack

How common is a silent heart attack?

Suffer in Germany about 280,000 people have a heart attack each year. So far it is estimated that every third heart attack is silent and thus without any noticeable symptoms runs. This means that in Germany, as in many other industrial nations, around 3 in 1,000 people have a heart attack every year. Thus happens a silent heart attack every year to about one in a thousand people. With regard to the frequency of silent heart attacks, however, it should be noted that 75% of people who have a heart attack, over 55 years old is. In particular, people with an increased risk (due to high-risk diseases, high blood pressure, poor blood lipid ratio, smoking, etc.) can suffer silent heart attacks even at an earlier age.

At what age are silent heart attacks particularly common?

Silent heart attacks occur especially in older age on. The risk starts having a heart attack in men from around 40 years of age to climb, in women is the risk Increased increased from the age of 50.
The risk for a silent heart attack is particularly high in the age group from 65 to 75 years. Especially the silent heart attack is going associated with diseases, which generally increase the risk of heart attacks. Type 1 diabetes mellitus, for example, is associated with an increased incidence of heart attacks, sometimes also in younger years. For this reason, you should not only pay attention to the signs of a silent heart attack from the age of 40 in men or 50 years in women.

Silent heart attack in women - what are the differences to men?

Unlike men feel Women often not the classic symptoms of a silent heart attack. Rather, they do especially unspecific signs noticeable. Often a silent heart attack goes with it Nausea and vomiting hand in hand. stomach pain or general upper abdominal pain are also possible symptoms.
While Men often a severe pressure or stinging in the chest notice, the silent heart attack shows up at Women rather by shortness of breath. Women should be one Sting feel, this is usually not in the chest area. Instead shine it in the arms or between the shoulder blades in the back. Discomfort in the neck and jaw area can also occur. Also recurring dizziness, Fainting spells and fatigue can be symptoms of a silent heart attack and are more common in women without other signs of a silent heart attack.

What is the life expectancy after a silent heart attack?

The damage to the heart during a silent heart attack sinks the Life expectancy. The reduced performance of the heart not only means less physical resilience. At the same time it also says that that Heart to compensate for many everyday exertions worse can. In the event of overload, the heart can easily be further damaged and thereby further reduce life expectancy.
Farther increases after suffering a silent heart attack that Risk of another heart attack on. Unfortunately, it is not possible to make specific statements about life expectancy (in years). These are depending on the risk profile of each individual, as well as of age, in which the silent heart attack took place.

You can find more information on our page on the topic Prognosis after a heart attack

How dangerous can a silent heart attack be?

In principle, a silent heart attack harbors that same dangersthat also a "Normal" heart attack brings with it. Basically, it is very possible to die of a heart attack.
Especially with a silent heart attack, they will unspecific signs usually not interpreted correctlyso that professional help is often not requested quickly enough. Because of this, patients who suffer a silent heart attack often find themselves there longer in the infarct stagewhat more damage to the heart arise.

Even if a silent heart attack goes smoothly, kick Consequential damage to the heart muscles on. In the event of a non-silent heart attack, these are treated quickly. In the case of a silent myocardial infarction, the prognosis and thus also the risk that the heart attack poses is also depends on, how quickly this is recognized. Only after the infarction has been recognized can countermeasures be taken and the persons concerned treated correctly.

Especially the first two hours after occurrence of the silent heart attack are for the further course crucial, which is why a late detection brings with it a lot of potential danger. Estimated die 5-10% of people who have had a silent heart attack, in the next two years due to heart problems.