Re: Silent MI in 31 year-old female

Posted By Barbara on October 02, 1998 at 12:38:40:

In Reply to: Re: Silent MI in 31 year-old female posted by CCF CARDIO MD-APS on October 02, 1998 at 09:11:08:






2 years ago I was diagnosed as having had a silent heart attack. The only symptom I had was palpitations, which I mentioned to my Internist during a routine exam. An ekg showed abnormal results, and an echo showed a small area of damage. I subsequently had a thallium stress test and a heart catheterization, which showed the damage from a "moderate" heart attack, although I had normal coronary arteries. None of my doctors could give me any reason for the MI, and they couldn't tell me when it happened. I do not smoke, take drugs, drink very rarely and am otherwise healthy, although I could stand to lose 30 lbs. I was told to take a lose-dose apirin daily (81mg) and thats it.  I had a repeat echo a year after diagnosis, which showed no change. Recent ekg's showed PVCs, but my doctor said not to worry about them. Since this diagnosis, my life has become a mess. I am nervous all the time and my palpitations have increased. Since nobody has told me what caused the MI, how do I know it won't happen again???  Every little twinge I feel in my chest causes panic. Sometimes I feel a "heaviness" in my chest, but I don't know if its just my nerves or if I should run to the emergency room! If I didn't know I was having a heart attack before, how will I know if it happens again??? My husband and I were planning to start a family prior to the diagnosis, but now I'm too scared to even think about  going thru a pregnancy.
What could have caused this to happen in the first place?  Please help!!!



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: Dear Barbara,
There are quite a few reasons why a young person with "normal coronary arteries" has an MI, or simply has heart muscle damage that was asymptomatic.
If you have not been investigated for such things as an increased thrombosis rate (tendency to form clots), or other abnormal anticoagulants, and connective tissue
disease, then you need to be before you get pregnant.  The main reason I say this is because the blood in pregnant women does clot easier than when they are not
pregnant and you need to know what you are dealing with before you venture in to it.
Some people have abnormal hearts when they are born, has this been considered?
As unlikely as that is, it is still a possibility and would easily explain why you felt nothing when it happened.
Have you been tested for spasm of the coronary arteries? Again, this is a infrequent diagnosis but it is more common in women.
I think you need to have all the "other" causes of heart damage investigated and although it will not give you an answer(sometimes no cause is ever found)
you need then to move on to a normal life and just accept the fact that you had this event, was unaware of it and thus are powerless to keep it from happening again.
Keep in mind Barbara that it is very, very unlikely to happen again in a person with normal coronary arteries (who doesn't smoke)
ESPECIALLY when there is no cause found for the original damage.  
Of course once you have the full work-up for ANY possible cause, you will need close follow-up with both OB and Cardiologist while pregnant.
A heaviness in the chest is a potential symptom of heart muscle ischemia (not getting enough oxygen and potentially going on to an MI)
so it would benefit you and your mind greatly to have an ecg done (at the doctors office or in the ER)
while having this heavy sensation.  If the ecg is normal with this sensation then again it is highly unlikely that this symptom is related to heart problems.
In order to not let this unfortunate incident run your life, you need to remember that it is almost impossible for doctor and patient to prevent something from happening when it is completely unknown how it happened
in the first place.  Good Luck and discuss these issues with your doctors, especially the desire to get pregnant.
Information provided in the heart forum is intended for general medical informational purposes only,
actual diagnosis and treatment can only be made by your physician(s).

Thanks for the above info.  I have a few additional questions:
You mentioned the possibility of being born with an abnormal heart - how would
a doctor be able to determine this? Could it appear like an MI scar?
What do you mean by "connective tissue disease" ?
I have not been tested for spasm - my cardiologist said that a spasm is usually painful and I would have felt something. Do you think I should pursue this?  
I had been on the pill prior to the diagnosis (not since)  for about 5 years - could that have caused this with a blood clot?  What about a virus?
Here's a list of additional tests that have been performed (all negative/normal results) : diabetes, excess iron, HIV, hepatitis, Lyme disease, clotting/coagulation problems, lipoprotein A, anti-phosholipid antibody test, anti-nuclear antibody test.  Can you think of anything else?

I have never worn a Holter monitor - would that pick up ischemia if thats what I'm feeling  when I feel "heaviness"?
I have asked both my Internist as well as a Maternal Fetal specialist about a possible prenancy, and all I've been told is that they have never seen a patient "like me"  (prior MI, no cause found, going thru pregnancy) and thus cannot
really advise me. Do you have any statistics for risks?
Sorry to bombard you with questions, but I really appreciate your help!
Thanks.