How silent heart attacks affect diabetics and high-risk groups

Silent heart attacks are more common in diabetics, basically because the nerves that supply the heart and the chest area where symptoms are normally predominant, they get damaged. And the patients who are diabetics do not have the same symptoms as a normal patient would have. Very often, diabetics would come with complaints of fatigue, feeling of breathlessness, feeling of tiredness, some vague abdominal discomfort, which are often misdiagnosed as symptoms of acidity or generalized weakness. And these often turn out to be heart attacks. The point here is that most of the heart attacks are not completely silent. There are few symptoms before the initial heart attack, which the patient very often disregards, because he thinks that it cannot happen to me. I am quite fit. I am exercising regularly. I cannot get a heart attack.
So, they never correlate the symptoms to be the same as that of a cardiac symptom. Very often, they are misdiagnosed as acidity. Very, very often misdiagnosed as acidity.
Very often misdiagnosed as generalized indigestion. Sometimes patients complain of jaw pain where they go to the dentist and the dentist keeps examining them, not knowing that these could be symptoms of the heart. I would say that patients who are diabetics, and India is a diabetic capital of the world, should get regular examinations done on a regular basis.
And also, they should get a regular health checkup done at least once in a couple of years, starting at the age of 40, if possible. Very often, a simple ECG or a simple stress test may pick up some signs of an impending cardiac problem, and you can act on it further. If the patient belongs to a family which has a strong family history of heart disease, even they would fall into a high-risk category.


And they should get investigated in terms of their routine blood cholesterol values, certain markers for prediction of a higher propensity for heart disease, and do a regular physical examination and also a stress test, if possible. CT coronary angiograms have become a common commodity nowadays, though I do not recommend CT angiograms as a regular screening tool for all patients. Some patients subsets who fall into a high-risk category in terms of being either a diabetic or hypertensive, or both, or people with a strong family history, or who have multiple risk factors like smoking, obesity, etc.
And we feel that these patients are at a higher propensity for developing a problem, of course, we can do a CT angiogram and rule out that these patients do not have any blockages. More than enough, usually a stress test, or what is popularly called as a TMT, can help in excluding the chances of major blockages to a certain extent. The sensitivity of a stress test is about 75 to 80%.
It is not 100% foolproof. So, I think we go by the history of the patient, the background of the patient, the risk factors of the patient, and we must also not dismiss stress as a risk factor. Stress is something which I would call as a non-quantifiable risk factor, and is very, very prevalent in today's population.
Not only that, childhood obesity is one thing we should try and avoid if we have to prevent this epidemic of coronary disease from progressing.

Authored by: Dr. Ajit Menon, Consulant, Cardiac Sciences, Sir HN Reliance Hospital