When tiredness is a sign you're having a SILENT heart attack

The trip had been months in the planning. A ten-day tour of Washington, Atlantic City and New York seemed the perfect way for Anthony Cottrell and his wife, Ellen, to celebrate their silver anniversary.

But as the couple toured the U.S. capital city, Anthony, then 48, found himself feeling increasingly tired. 

‘I just couldn’t work it out,’ reflects Anthony, a transport coordinator from Durham. 

‘I was used to walking a lot but suddenly I just felt sluggish. We’d walk for 20 minutes and then I had to sit down for a while. Ellen and I put it down to jet lag, or that I wasn’t as fit as I thought I was.’

In the first month of lockdown, a survey by the British Heart Foundation found 84 per cent of doctors said the number of people coming to hospital with even the most serious type of heart attack — where there is almost a complete blockage — had fallen

In the first month of lockdown, a survey by the British Heart Foundation found 84 per cent of doctors said the number of people coming to hospital with even the most serious type of heart attack — where there is almost a complete blockage — had fallen

In fact, Anthony was experiencing the fallout from a silent heart attack.

may have us believe heart attacks involve dramatic chest pain. Yet many can be overlooked — vague symptoms dismissed as a virus or fatigue. Occasionally, there are no symptoms at all.

But silent myocardial infarction (SMI) — as it is medically known — accounts for up to 50 per cent of the 100,000 heart attack hospital admissions each year.

They’re ‘silent’ since they lack the intensity of classic heart attacks, such as chest pain, stabbing pain in the arm, or sweating and shortness of breath.

Yet internally they’re identical to a normal heart attack — the blood supply to the heart is suddenly blocked by a build-up of fat and other substances in the arteries that feed it — causing damage to the tissue. The damage can be cumulative, leading to potentially fatal blockages.

Sometimes SMI is truly silent,’ says Jerome Ment, a consultant cardiologist at University Hospitals Birmingham NHS Foundation Trust.

‘That is, there are no symptoms at all. Patients may come in for a routine operation and, as part of the preparation, have an ECG — electrocardiogram — a simple test to check the heart’s activity.

‘The results might show damage that tells us they have had a heart attack even though they, say, have been playing golf three times a week. Inevitably, it comes as a shock.’

The problem has been compounded by the pandemic since many people stayed away from hospitals.

In the first month of lockdown, a survey by the British Heart Foundation found 84 per cent of doctors said the number of people coming to hospital with even the most serious type of heart attack — where there is almost a complete blockage — had fallen.

There are obvious risk factors for having a heart attack such as excess weight or a family history of heart issues, but often it can be difficult to predict who may have one, says Dr Ment.

Signs to watch out for

You may not have classic chest pain or shortness of breath but may experience:

Fatigue Uneasiness Heartburn Sluggishness or difficulty breathing Feeling faint, dizzy or weak Finding it hard even to do limited exercise

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‘We know, for example, that those with type 2 diabetes are more vulnerable to silent heart attacks. This may be because the condition impairs the nerve supply to the heart so there is no pain. But then more women suffer silent heart

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