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

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;

• Indigestion.

Heart attack patients with a history of depression presenting at emergency departments were less likely to receive priority care than people with other conditions, found a study published in CMAJ (Canadian Medical Association Journal).

Several studies indicate that people with heart attacks and depression have worse outcomes than people without, although emergency department care has not been looked at as a possible contributor. in the United States, more than six million patients with mental health issues are seen in emergency departments each year and six million people visit for chest pain.

This study, by researchers from the Institute of Clinical Evaluative Sciences, looked at data on 6,874 patients admitted to 96 acute care hospitals in Ontario, Canada from April 2004 to March 2005. they found that 680 of these heart attack patients had a history of depression recorded in their medical charts, and 39% of these were assigned a low priority triage score in the emergency department, compared with 32.7% of the other patients with heart attacks.

“Ten per cent of acute myocardial infarction patients seen in the emergency department had a history of depression recorded in their chart, and it was associated with an increased risk of receiving a low priority emergency department triage score, as well as delays in diagnostic testing and definitive care,” writes Dr. Clare Atzema, Institute for Clinical Evaluative Sciences, with coauthors. “Interestingly, other components of the medical history, including the traditional cardiac risk factors of diabetes, smoking, hypercholesterolemia and hypertension, were not associated with triage score in the models; only depression affected the score.”

As well, a lower triage priority based on charted depression resulted in delays in diagnosis and treatment by physicians, nurses, cardiologists and laboratory teams.

The authors suggest this lower prioritizing by emergency staff may be based on assumptions that patients’ symptoms are anxiety-related rather than due to an actual heart attack. Less than 10% of patients who come to emergency rooms with heart attack symptoms, such as chest pain or shortness of breath, are found to be suffering from the condition. Therefore staff are actively looking for other possible sources for the patients’ symptoms.

“We suspect that mistriage of these patients is not due to purposeful discrimination by emergency department staff, but rather that most emergency department staff are unaware of data that suggests a link between depression and coronary artery disease,” write the authors. they suggest this information needs to be disseminated to emergency room staff.

Provided by Canadian Medical Association Journal (news : web)

okay i am 18 i have had a baby i had high blood pressure when i was pregnant well i have horrible anxiety my right leg is aching something terrible and its in the upper part of my thigh. my jaw was hurting earlier when i was laughing a lot and when i was at the gym i was checking my heart rate on the treadmill and it was like 140 then it would go 139 138 137 and keep going down then it would go back up then it would stay but it has never done that and i didn't know if it was normal. i am freaking out i have no chest pains or any other symptoms i am really scared that i am having a heart attack cause i Google the symptoms of them and its making me nervous?

Um, it doesn't sound like a heart attack to me. Your just stressing yourself.
Heart attacks usually come with a numb left side or chest pain or even nausea. … If you only had those symptoms, it doesn't really sound like a heart attack. Do you have heart palpitations.

Oh sorry ==' didn't read your questions right, you checked your heartrate. Well, then it only labels it down to you stressing. Like the other person said, panic attacks. I had them before, nasty things. Well, all you can do now is take a deep breath or two and tell yourself to calm down…

If you are very stressed out, i would advised you talking to a persn from your support network(people you trust).

If no one is there with you at the moment, and you feel that you are right and you are about to have a heart attack… go to the hospital or ring an ambulance. Stop stressing, it will only make things worse.

I never heard of a heart attack having the symptoms you relay. actually from what I've heard it is with pain in the left arm usually, then goes to the chest area. I would talk to your dr. about your pain, maybe you are having some exercise related pain. Perhaps you are not using the treadmill correct or at the right pace for you? Just a thought on this one.

Or you could have some circulatory related problem with that leg also?

HOW can you tell if you or someone you know is having a heart attack? sometimes the symptoms can be surprisingly subtle.

“They can be very different from person to person, between women and men and even within an individual who has more than one heart attack,” says Dr. David Rizik, director of Interventional Cardiology for Scottsdale Healthcare Hospitals, in Scottsdale, Arizona. Men and women may experience atypical heart-attack symptoms.

In contrast to the “classic” chest-splitting, gasping-for-breath symptoms, many heart attacks begin with symptoms that are so mild they are often mistaken for indigestion or muscle ache.

Symptoms

MEN and women may experience any or all of the following symptoms, according to the National Heart, Lung and Blood Institute (NHLBI):

·         Mild to strong discomfort in the center of the chest, which may be prolonged, or come and go.

·         Chest discomfort may feel like pressure, squeezing, fullness or pain.

·         Discomfort may occur in one or both arms, the back, neck, jaw and/or stomach.

·         Shortness of breath, before or with chest discomfort.

·         Cold sweats, nausea and/or light-headedness.

Gender differences

According to the NHLBI and the Centers for Disease Control and Prevention, women are more likely to experience shortness of breath, nausea, vomiting, back or jaw pain, indigestion, flu-like symptoms and shoulder pain.

In a study published by the American Heart Association, women rated their most frequent preheart attack symptoms as fatigue, sleep disturbances, shortness of breath, indigestion and anxiety. Most of the women first felt these symptoms more than one month before the heart attack.

The majority of the women in this study didn’t experience chest discomfort or pain, and those who did were more likely to describe it as pressure, aching or tightness.

Women are more likely than men to ignore or misinterpret heart-attack symptoms, to delay seeking emergency treatment and to die of sudden cardiac arrest.

If it’s a heart attack

“THE patient’s symptoms and an EKG [electrocardiogram] are the best way to establish a diagnosis of a heart attack,” Rizik said. “If the EKG is consistent with a heart attack, we immediately start the patient on blood-thinning agents and take them to the cardiac-catheterization lab, where a diagnostic angiogram is performed. if there’s a blocked artery, we perform an angioplasty procedure to open the blockage.”

Rizik says educating the public about the symptoms of a heart attack is of utmost importance: “Getting quick treatment is vital to preventing as much heart damage as possible.”

Did you know?

·         The average age for a first heart attack is 66 for men and 70 for women. But people in their 20s and 30s also have heart attacks.

·         between 70 percent and 89 percent of sudden cardiac events occur in men.

·         An American has a cardiac event about once every 25 seconds, and an American dies of one about once a minute.

·         Coronary heart disease is the No. 1 killer of women and men in the United States.

·         Women are more likely than men to have other conditions—such as diabetes, high blood pressure and congestive heart failure—that make it even more vital that they get immediate treatment.

Sources: Centers for Disease Control and Prevention, National Institutes of Health, American Heart Association

Heart Matters National Heart Foundation heartfoundation.org.nz

At 40 years old you expect to have a lot of living ahead of you; to see your family grow up, enjoy your grandchildren or perhaps do some travelling.

Sadly, not everyone has the opportunity to enjoy these things.

With one New Zealander dying from heart disease every 90 minutes (an average of 16 deaths a day) heart disease is the country’s number one killer of men and women.

Heart disease is tearing families apart. once considered to be  an ‘old man’s disease’,  the rate of heart attacks in younger adults is currently increasing and heart disease is the single biggest killer of men aged over 35 years. Many people have no idea they are at risk, particularly if they are reasonably fit, not overweight, don’t smoke and have no symptoms.

Many premature deaths from heart disease are avoidable and the Heart Foundation urges New Zealanders to have their hearts checked.

Wendy Bryson, clinical nurse specialist for cardiology at Tauranga Hospital says that people are not getting the message about early detection. She believes that most young people (25-40) and often older people as well, don’t think about their hearts and often think a bit of discomfort is indigestion or a pulled muscle. Even at an early age it could be your heart, so make sure you get any symptoms checked out quickly, for your own sake and for your family’s.

Having a heart check and knowing your risk could save your life. for some it may just require a change of lifestyle, for others medical treatment.

A good place to start is the Heart Foundation’s online heart health risk assessment tool – Know Your Numbers. first ask your doctor for your blood pressure and cholesterol numbers and then go to knowyournumbers.co.nz.

The easy to follow site will predict your risk of heart disease based on the information you provide, and provide advice on changes you can make to reduce your risk. 

It’s well worth a visit and may motivate you to make simple changes that will improve your heart health or even save your life. 

The Heart Foundation’s goal is to stop New Zealanders dying prematurely of heart disease and as a not-for-profit, non-government organisation it is reliant on the generous support of everyday New Zealanders. our annual appeal street collection on February 11-12 provides an opportunity for people to support the work of the Heart Foundation.

Your donation will be used locally and will help to save lives. you can also volunteer a few hours of your time to collect on our street collection day on February 11 -12.

For further information, call Sandy at the Heart Foundation (07 571 3013) and look out for next month’s ‘Heart Matters’ to learn more about your heart health.

There’s more than joint pain to watch out for.

Painful, swollen joints are a hallmark of rheumatoid arthritis. but for people with RA, it’s not the only thing to watch out for.

A result of the body’s immune system attacking its own tissues, rheumatoid arthritis requires more than just managing the pain. Other symptoms that might even seem unrelated to the condition may pose a threat.

“This is a disease process, not just something that happens in the joints,” rheumatologist Joan Bathon, MD, tells WebMD. “It can be in all your tissues, causing problems wherever inflammation occurs,” says Bathon, who is chief of the rheumatology department at New York-Presbyterian Hospital/Columbia University Medical Center.

People with more severe rheumatoid arthritis are more likely to have other complications. but it can also happen in milder cases.

Here are the top 10 symptoms rheumatoid arthritis patients should never ignore.

1. Shortness of breath or chest pain

Because rheumatoid arthritis can affect the blood vessels and muscle of the heart, people with the condition are at a greater risk for heart attacks and heart failure.

“Chest pains or shortness of breath are big red flags,” says rheumatologist Brian Mandell, MD, PhD, of Cleveland Clinic’s Arthritis and Musculoskeletal Center.

If you’re getting winded easily, you could also have a lung infection. Or you could have some form of interstitial lung disease, which causes lungs to become inflamed and scarred, Mandell says. Fluid might also be surrounding the lungs, which would require drugs and drainage to treat.

Seek medical attention immediately if you’re having these problems, even if you’ve never had heart or lung issues before.

2. Numbness or tingling

Rheumatoid arthritis can cause connective tissues in the hand or foot to become inflamed and push up against a nerve causing numbness and tingling. As a result, you might experience weakness or clumsiness, or even nerve damage.

This type of swelling can happen in tissues throughout the body. but it most commonly occurs around the wrist area, causing carpal tunnel syndrome, Mandell says.

If you experience numbness or tingling, you need to be evaluated by your rheumatologist or another health care provider as soon as possible to determine the cause.

3. Inability to move or raise your hand or foot

Compared to numbness or tingling, suddenly not being able to raise or move a hand or foot is a much more severe complication to result from rheumatoid arthritis. 

It’s also a much more rare occurrence, involving damage to nerves that are connected to muscles.

“It’s like having a heart attack for the nerves,” Bathon tells WebMD.

Seek emergency treatment for this symptom. Bathon says not doing so could lead to permanent paralysis.