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Silent But Deadly

I recently saw a medical patient that was doing perfectly well until he noticed a very strange chest discomfort at the end of his usual 1 hour of daily exercise.  The patient had essentially no risk factors for heart disease, except for one (aside from age over 60):  Family history of coronary artery blockage.  The other risk factors he did NOT have: diabetes, hypertension, cigarette smoking, obesity or high cholesterol.  I referred the patient to a cardiologist and the workup, which included a nuclear stress test (this was abnormal) and cardiac catheterization showed three coronary arteries that were blocked.  One of the blockages was a 99% narrowing of the left anterior descending artery, otherwise known as the “Widowmaker”.   The patient underwent a successful angioplasty procedure that opened up his arteries 

I saw the patient after the procedure and his questions mostly revolved around:  “Why did this happen to me?  I keep myself in shape and doesn’t this stuff only happen to people that have lots of risk factors?”  My answer focused on the importance of genetics and family history that often override even the best/healthiest of lifestyles.

The point:  There are instances when the body fails to “warn” us about impending healthcare calamities.  Heart attacks/sudden deaths are often not preceded by the warning signals of chest pains/shortness of breath episodes.  Strokes are often not preceded by transient ischemic attacks where stroke-like symptoms occur but only lasting for seconds/minutes.  There are situations, mostly revolving around cardiovascular issues, when the first manifestations of those diseases are a life-threatening health devastation.

Two points to be driven home by this entry and then one frat house joke:

Point 1:  Poor weight control dramatically increases the risk of developing the aforementioned life-threatening diseases, i.e. heart attacks and strokes.  Getting that weight down and maintaining the healthier weight will help reduce those chance.

Point 2:  Because some people do not have warning signals, their diseases progress silently, yet headed towards a deadly course.  Depending on your age/risk factors, screening tests, such as exercise stress tests and carotid artery ultrasound tests should be performed to ensure that you are not silently (i.e. no symptoms) developing significant vascular disease.

Frat house joke:  The “Silent But Deadly” phrase has been used before, but not referring to artery blockages.  Remember those immature ages when you were with a group of friends and then a horrible smell occurred without first hearing a gas emission (i.e. fart)?  The person that was responsible for that smell would proudly state: “Silent, But Deadly”.

Okay, out of the fraternity house and back into serious medicine:  Lose that weight!

Summary:  At times, artery blockages in the heart and carotids can not produce symptoms before a catastrophic medical event occurs such as a severe heart attack, sudden death or stroke.  Screening tests are important for those people with any risk factors.  Weight control reduces those risk factors.

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