Cardiologist Gaurav Gandhi’s death: What tests can indicate silent heart attacks risks?

The obvious challenge is that most patients do not experience known symptoms — a stabbing pain in the arm, neck, jaw and chest, dizziness, anxiety and sweating. Often it seems like a regular gastric discomfort. Also, such episodes appear to be brief and, therefore, seem to be just another manageable body condition.

What many do not realise is that whether apparent or silent, the damage done to the heart by myocardial infarction is just the same. A study in the Journal of the American Medical Association on November 10, 2015, looked at almost 2,000 people aged between 45 to 84, who were free of cardiovascular disease at the time of testing. Within a decade, eight per cent had myocardial scars, which are evidence of a heart attack. About 80 per cent of these people were unaware of their condition.

It is a myth in our population that ECG is the only diagnostic tool for detecting heart disease and that if normal, is a certificate of heart health. This is a myth. ECG can diagnose only old heart disease, an elapsed cardiac event or when a patient is having a heart attack at the moment of testing. So, we cannot diagnose silent heart disease with a simple ECG. There are a few tests which are recommended beside ECG to rule out silent heart disease. To be sure, take the Troponin T or Trop T test. This measures the levels of troponin T or troponin I proteins in the blood. These proteins are released when the heart muscle is damaged, usually after an attack. The more the heart is damaged, the greater the amount of troponin T in the blood. It’s a sureshot marker of a cardiac event. That’s why the patient is kept under observation for a few hours.

How to look for a silent blockage in heart arteries?

One of the important tests is echocardiography, which is a 10-minute ultrasound of the heart. This is a simple OPD procedure. The second procedure is the treadmill test or what we call an exercise tread test. If both these tests show some abnormalities, then cardiologists recommend additional tests. The treadmill test or TMT is a simple test where the patient walks on a treadmill machine as per his exercise capacity. If we see any ECG changes during the exercise, then it is indicative of some problem. But yes, TMT can be falsely positive or negative too in around 10-20 per cent of cases. That’s why cardiologists don’t just rely on the TMT. If there are risk factors and if the symptoms are very typical of a heart disease, then we advise different tests. The third most important test is calcium scoring, which maps arterial deposits or plaques. If the score is more than 100, it means the patient is at a risk of severe or critical heart disease. But the good part about these predictive tests is that medical intervention can be done early on.

What should our annual cardiac test profile now look like?

Every year one should have an annual checkup which consists of some simple tests like lipid profile, HSCRP (a high sensitivity C-reactive protein) test, whose elevated levels indicate inflammation, homocysteine levels (Homocysteine is an amino acid, high levels of which can age the inside of your arteries and increase your risk of forming blood clots. This may increase your risk for heart attack, stroke, and other heart diseases and blood vessel disorders) lipoprotein levels and HbA1c tests. Those in the prediabetes stage are at the risk of a silent heart disease. If your cardiologist feels there is something concerning in these routine tests, the person may advise specialised tests.

Who is likely to get more silent heart attacks?

As I mentioned diabetics, women and anybody with a higher pain threshold. Some have cardiac ischemia, where a coronary artery blocks suddenly but the blood manages to flow through despite a 70 to 90 per cent plaque. In this scenario, you do not feel any pain. If discomfort or similar symptoms show up while walking and disappear when you stop and rest, then these can be cardiac-related warning signs.