Tuesday, February 14, 2006

Not all heart attacks are typical

We have written previously that 40% of heart attacks strike without warning and sudden collapse is the first and only manifestation. Apart from these sudden cardiac death or Primary Ventricular Fibrillation (1o V.Fib.), alomost 30% of in the male risk age group and almost 50% in the females risk age group, may have very atypical symptoms when presenting with a heart attack. This was highlighted in a piece of research done in Rotterdam, by the group in Eramus Thoraxcenter, and reported in the latest issue of the European Heart Journal. They studied about 4,000 subjects and made this interesting finding.

I remember my old professor of radiology who had suffered a heart attack while working. One morning, about 20years ago, we (the head of cardiology-UH, senior cardiologists and myself - a junior trainee then) were doing our angiogram list in UHKL. The head of Radiology, a 50year old sikh gentleman walked in and mentioned to the "boss" that he was not feeling well, and had some gastric upset. My "boss" sent one of us to get him some mist magnesium trisilicate. After our morning angio list we went to see the haed of radiology and he said that he was still not feeling well. We quickly asked him to lie down and did an ECG which showed an acute inferior myocardial infarct (heart attack). The point here is that even the chief of cardiology can have trouble diagnosing a heart attack on history taking alone.

The lesson is obvious, that if you are in the cardiac risk group viz, males >40years old, or females >50years old, who are also diabetes, hypertensives, obese, cigarette smokers, hyperlipidemias, and if you should feel off colour or generally unwell, do an ECG. There may or may not be chest pains. If after 6-8 hours and your are still off colour, do a second ECG. If the complaint is typical chest pains going down the inner aspect of the left arm, that's easy. If it is not so typical, have a high index of suspicion, then do an ECG. Yes, we are maybe over doing ECGs, but an ECG is so cheap and so harmless, yet can be so rewarding. There are certain CVS risk groups who are prone to atypical features of AMI, viz females, the elderly ( >70years ), the diabetics, those are recoverying from non-cardiac surgery, those who have co-morbidities like chronic asthmatics or chronic arthritics on steriods, etc. Whenever in doubt, see the nearest doctor, and always do an ECG, and if necessary, blood test like cardiac enzymes, and troponin T or I. Remember, in heart attacks, time is heart muscle loss.

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