Devastating toll of heart attacks you don't know you've had
By Anna Hodgekiss
When Andrew Frankish became slightly breathless carrying his bins out, his GP initially suggested it might just be a bug.
But after a month the 38-year-old still felt out of sorts and asked to be referred to a specialist. Andrew was astonished by what the expert told him — his lack of breath was due to a heart attack.
In fact he’d had not one, but two — with no obvious symptoms.
Like most people, Andrew associated heart attacks with high drama — people suffering crushing pain and clutching their chest in agony while collapsing to the floor.
Shock: Andrew Frankish and wife Verona, who thought he was paranoid. He had two heart attacks - but with no obvious symptoms
In his surgeon’s opinion, however, he’d suffered what is known as a silent heart attack — where symptoms are vague or even non-existent.
This can be just as serious as a ‘classic’ heart attack — sometimes worse, as the damage can go undetected for many years, with worrying consequences.
There are around 124,000 heart attacks recorded in the UK each year — and experts believe thousands more go undetected.
‘It’s estimated that between 25 and 30 per cent of all heart attacks are silent,’ explains Dr Ever Grech, a consultant cardiologist at the Northern General Hospital and BMI Thornbury Hospital in Sheffield.
‘With silent heart attacks, you don’t get the typical crushing chest pain. Some people may get vague symptoms such as feeling generally unwell for a few hours, accompanied by a bit of jaw ache as the pain can spread, or what they think is indigestion, but nothing like the classic symptoms.’
Yet despite the lack of symptoms the heart can still be damaged. Any heart attack usually begins with a sudden blockage in one of the coronary arteries that supplies the heart muscle with blood, causing part of the muscle to die.
Once the heart is damaged and scarred from a heart attack, it can’t repair itself.
‘If any heart attack symptoms go unnoticed then it’s not unusual for someone to go on and suffer heart failure as a result,’ says Professor Peter Weissberg, medical director at the British Heart Foundation.
‘In fact, unrecognised heart attacks are often only picked up when the patient presents with symptoms of heart failure, such as breathlessness, and we track backwards to work out why.’
Andrew, from Nottinghamshire, is the managing director of a financial services company. He only realised something was wrong when everyday tasks suddenly became more arduous.
‘I found myself short of breath when I took the bins out or carried the kids upstairs at night,’ he recalls.
‘I couldn’t understand it, as I play quite a lot of football and squash so have always considered myself to be quite fit and healthy. I’ve never smoked and I am by no means a heavy drinker.
‘At first, I presumed because I was nearly 40 that everything was slowing down and it was going to be harder to keep in shape. But as the weeks went by, I felt increasingly out of sorts.’
Andrew’s GP suggested he might be suffering from a bug. But four weeks later, he felt no better. ‘It wasn’t anything that stopped me from working, but I just knew I didn’t feel right.’
Andrew only realised something was wrong when everyday tasks suddenly became more arduous
Because heart problems run in his family — his father survived a heart attack at 51 and two of his brothers have had heart issues — he asked to be referred to a specialist under his private medical care.
‘My wife Verona thought I was being paranoid and my GP was actually quite sarcastic, but I didn’t want to take any chances.’
It’s a decision that probably saved his life. Referred to a cardiologist in Sheffield in January last year, Andrew had an exercise electrocardiogram (ECG) test, where patients run on a treadmill to see how their heart copes.
‘After a few minutes I began to feel quite uncomfortable and breathless and had to stop much earlier than the average person my age — I was told I should be able to run for ten to 15 minutes. That really worried me.’
Andrew then had an angiogram — where a flexible tube is inserted to check for narrowed or blocked arteries. He was completely unprepared for the news that followed.
‘The doctor said that two out of the three major arteries in my heart were blocked. The third was also significantly narrowed.
‘I was told I’d almost certainly suffered two heart attacks. And I was heading for a third, and probably fatal, one. No one could say when I’d had the attacks, but it’s likely my arteries had been blocked for a few years.’
Despite his diagnosis, Andrew could not recall any previous occasion when he felt pain.
‘I can only think that one of the heart attacks might have happened when I was playing Wii (a computer game where players mimic real-life exercise) with the family and I thought I’d pulled a muscle in my chest from over-exertion.’
But why do some people like Andrew feel nothing when they suffer a heart attack?
Usually in a heart attack the body produces chemicals that then affect the nerves, causing symptoms such as chest pain.
In some cases the nerves aren’t stimulated, perhaps because fewer chemicals are released.
‘The problem with heart attacks is that when it comes to a patient noticing them there are various shades of grey,’ says Prof Weissberg.
‘I always ask my patients whose ECG shows they’ve had an unrecognised heart attack to really think back.
‘They can normally remember a time when they had an odd sensation but put it down to indigestion or the odd twinge.’
Occasionally, people don’t feel a heart attack because over time the heart has successfully managed to compensate for the lack of blood supply by using other coronary blood vessels.
This appears to be what happened in Andrew’s case.
‘Fortunately for him, the little capillaries around the blockage had created their own bypass around the artery. Effectively, the heart had done its own bypass,’ explains Dr Grech, who treated Andrew.
‘There are some patients, however, who have no idea they’ve suffered a heart attack until they present with symptoms such as lethargy and severe breathlessness — and we discover they are suffering heart failure following the undiagnosed heart attack.’
So who is most at risk? Diabetics, because high blood sugar levels can damage nerve endings so they are less likely to feel tell-tale chest pain, according to studies.
And Dr Grech says evidence suggests that women and those over 65 are also more at risk.
But while heart attacks are linked to heart disease, smoking and high cholesterol, for Andrew it was his genes that let him down.
‘Family history is a very important independent risk factor, regardless of how healthy you may think you are,’ explains Dr Grech.
‘Patients like Andrew who have a parent or other first-degree relatives with premature coronary disease (less than 55 years) will have to be extremely careful.’
Andrew also believes his weight didn’t help. At 6ft 3in and 17st, he needs to lose about 3st to be considered a healthy weight.
‘I know I am overweight, but I didn’t think I was heading for a coronary at 37,’ he says.
‘I’m sure there are lots of men like me who think they’re “not that bad” — hopefully my experience will make them think about their health.’
Fortunately — and unusually — Andrew has not suffered any severe long-term damage. He was lucky his blocked arteries could be opened up using stents (small metal tubes) rather than undergoing major heart surgery.
Like all patients with stents, he now takes blood-thinning drugs to prevent clots from forming around them.
‘I feel great now,’ says Andrew. ‘I can run around the garden with my three-year-old son and six-year-old daughter and have a lot more energy. I feel very lucky that my problems were caught.’
For more information go to bhf.org.uk
THE TELL-TALE SIGNS
Although silent heart attacks often have no symptoms, doctors have identified some signs that can be easily overlooked but could signal something is wrong.
- Unexplained breathlessness;
- Slight chest discomfort — the feeling of a pulled muscle;
- Generally feeling unwell or nauseous for a few hours;