My friend's husband has been told that he is on administrative leave from his job because an EKG read that he has had a heart attack. They told him he must have this procedure done to measure his heart size before going back to work. The issue is that he feels fine and says that he has never had a heart attack. Is that possible that he could 've had an attack and didn't even know? How could that have happened and why?
Dear Julie, thank you for your question. A silent heart attack can occur for two reasons. First, the chest pain from a heart attack could be ignored or misinterpreted as non-cardiac chest pain. In this case, medical attention is usually not sought, so a diagnosis of a heart attack is never made. Second, some people have a diminished response to chest pain to the point where they may never have felt chest pain with a true heart attack. However, the ECG is not completely infallible in diagnosing a heart attack. There is an ECG abnormality called a Q wave that occurs after a heart attack and is a marker of the location of a prior heart attack depending on which leads Q waves are found on an ECG. However, Q waves can sometimes be seen on an ECG when a prior heart attack has not occurred. To determine the significance of Q waves, a test called an echocardiogram is performed. An echo is an ultrasound of the heart that images the contractile function of the left ventricle. If a heart attack has occurred that produced Q waves, then a portion of the left ventricle should have reduced contractile function in the area identified by the Q wave location on the ECG. The echo is also used to measure heart size. If your friend's husband has a completely normal echo, then it's doubtful that he had a prior heart attack and that the ECG abnormality was falsely positive. However, your friend's husband should speak with his physician for a more definitive answer/explanation.
I hope this information is useful. Information provided in the heart forum is for general purposes only. Only your physician can provided specific diagnoses and therapies. Feel free to write back with further questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
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