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Entries in Chest Pains (2)

Tuesday
Sep042012

Unrecognized Heart Attacks Common, Deadly

iStockphoto/Thinkstock(BETHESDA, Md.) -- For every heart attack that strikes with chest pain, shortness of breath and nausea, almost two more slide under the radar among older adults, a new study found.

The imaging study of 936 elderly men and women in Iceland found 17 percent had signs of an unrecognized heart attack: a blood vessel blockage that scarred the heart, according to MRI images, without sparking the symptoms that land patients in the hospital. Less than 10 percent of study participants had a heart attack with recognizable symptoms.

"The fact that there were more people with unrecognized heart attacks than recognized heart attacks suggests it's a big problem," said study author Dr. Andrew Arai of the Bethesda Md.-based National Blood, Heart and Lung Institute, a division of the National Institutes of Health.

But the problem gets bigger. Unrecognized heart attacks are almost as deadly as "full-blown" symptomatic ones, Arai said. Of the 157 people whose heart attacks went unnoticed, 44 died within eight years of follow-up.

"I think doctors need to be looking more carefully for this," said Arai, whose study was published Tuesday in the Journal of the American Medical Association. "And maybe we should be treating these people a little more aggressively. If someone we know had a heart attack, we work twice as hard to lower their cholesterol."

Arai said about half of patients who had evidence of an unrecognized heart attack recalled having symptoms they chalked up to the flu or indigestion at the time.

"But the other half had no idea," he said, adding that patients are often surprised to hear their hearts have been damaged. "Maybe it happened in their sleep. Or in people with diabetes, maybe they just didn't feel it."

Roughly 28 percent of the study participants had diabetes, which can cause nerve damage that blocks the warning signs of a heart attack, said Dr. Martha Grogan, a cardiologist at the Mayo Clinic in Rochester, Minn., who was not involved in the study.

"Diabetics often have atypical symptoms or none at all," Grogan said, stressing that the elderly and largely diabetic Icelandic study population -- 60 percent of whom smoked -- are not representative of the greater population.

But even in the greater population, Grogan added, "Heart attack symptoms are often vague and start out slowly."

"It's not like the Hollywood heart attack, where someone grabs their chest as they fall to the ground," she said. "Some people think they have a bad case of the flu, they feel achy and run-down. Some people think they have heartburn."

Because damage from unrecognized heart attacks can only be detected by pricy MRI scans and can't be undone, preventing the damage is key, according to Grogan.

"If you think you might be having a heart attack, err on the side of getting checked out," Grogan said, adding that blood tests can quickly detect the signs of a heart attack, and medications can restore blood blow and prevent irreversible harm.

"Don't feel silly or feel like you're imposing. If you go to the emergency room and it's not a heart attack, trust me, everyone will be happy."

Copyright 2012 ABC News Radio

Thursday
Jul072011

Stem Cell Injections into the Heart Could Stave Off Chest Pain

Medioimages/Photodisc/Thinkstock(CHICAGO) -- George Reed's heart wasn't doing so well: he's 71 and after suffering a heart attack years earlier, Reed had undergone open heart surgery and was put on multiple medications. But nothing seemed to help the dizziness and chest pain he experienced daily.

Reed continued to experience angina, a type of chest pain that occurs when the heart doesn't get enough oxygen-rich blood.  Angina can also be accompanied by dizziness. So when Reed was recommended for an experimental study that would inject his own stem cells into his damaged heart, he signed on.

Researchers gave Reed a drug commonly used in bone marrow transplants that stimulates the marrow to make more stem cells. Then they removed some of Reed's blood, isolated the stem cells and injected them into and around the damaged areas of his heart.

Within a few months, Reed, along with many of the other 100 or so patients at 26 hospital centers who'd received this stem cell treatment, reported feeling better than he had in years.

If the positive results seen in this study hold up in the next phase of the study, which is set to begin enrollment in the fall, this type of cardiac stem cell injection could be added to the arsenal of weapons against angina. The upcoming phase three trial has already been approved by the Food and Drug Administration.

While several smaller studies have suggested that injecting stem cells into damaged heart tissue might be effective, this study, in its scope and rigor, was the first of its kind. A total of 167 patients were recruited and randomly assigned to receive a lower dose of stem cells, a higher dose or a placebo. The patients didn't know who got what treatment, and neither did the doctors treating them.

When tracked for a year after the injection, patients who received the lower dose of stem cells could last longer during a treadmill exercise than those who had received the placebo, and they averaged seven fewer episodes of chest pain in a week. To put this in perspective, a popular drug to treat angina, Ranolazine, reduced chest pain by fewer than two episodes a week in clinical trials.

Although the goal of the stem cell shots was to grow new blood vessels, it's impossible to tell if these stem cells were actually growing into blood vessels or if they were just triggering some other kind of healing process in the body, Henry says. Tests in animal models, however, do suggest that new blood vessels are forming, says Dr. Marco Costa, a co-author of the study and George Reed's doctor.

For now, the only gauge of the injections is improvement in symptoms.

Despite the positive results of the study, cardiologists remain "cautiously optimistic" about stem cells as a treatment for angina. The fact that lower doses of stem cells were more effective than larger ones is puzzling and cause for caution, says Dr. Steve Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic.

"The jury is still out for stem cell therapies to treat heart disease," says Dr. Cam Paterson, a cardiologist at the University of North Carolina at Chapel Hill.

Even so, the results so far provide cautious hope for heart patients.

Copyright 2011 ABC News Radio







ABC News Radio