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    EKG suggested I had silent heart attack
    calcram posted:
    My EKG suggested I had a silent heart attack so my Dr. sent me to get a coronary calcium cat scan, which came out perfect, 100% clear, no calcium build up. My question is: can you have a heart attack if you dont have any calcium/blocked arteries?
    CardiostarUSA1 responded:

    "Can you have a heart attack if you don't have any calcium/blocked arteries?


    By the way, as reported, soft plaque is more dangerous and unpredictable than hard or calcified plaque (calcification is an organized, regulated process similar to bone formation).

    Heart attack without calcium or blocked arteries

    As applicable, there's a specific condition known as coronary artery spasm (CAS), which is a transient constriction or a transient total closure of a coronary artery (typically, but not 100% always, occurring at rest, causing chest pain, i.e., Prinzmetal's or variant angina, and/or other symptoms). CAS may/can lead to a heart attack if spasms are prolonged or are of extended-duration.

    Also, one second you can have a totally clear coronary artery, and then whammo, a vulnerable plaque (VP) ruptures or bursts, resulting in blood clot (thrombus) formation, causing a heart attack.

    VP (a 0% blockage, though unequivocal atherosclerosis, and typically symptomless) is now recognized worldwide as the cause of the majority of heart attacks.

    Most of the plaques involved in coronary artery disease (CAD) are not the plaques that significantly narrow the artery.


    "Only one in seven heart attacks is caused by a blockage of more than 70 percent. It's the classic tip of the iceberg problem. We've become facile at treating the tip of the iceberg, BUT the most dangerous part is still below the surface."

    - Steven E. Nissen, M.D., vice-chairman of Cardiology, head of Clinical Cardiology, Cleveland Clinic

    "The angiogram is just shadows, it doesn't tell us what's going on in the vessel wall, where all the action is at."

    - Eric J. Topol, M.D (formerly of the Cleveland Clinic)., cardiologist, professor of medicine, Department of Molecular and Experimental Medicine, chief academic officer of Scripps Health and director of the Scripps Translational Science Institute


    ALWAYS be procative in your health care and treatment. Best of luck down the road of life.

    Take care,


    WebMD member (since 8/99)



    Be well-informed

    L@@K Back in the Media

    TIME Magazine Online - Health and Science section 3/24/02

    Soft and deadly, "vulnerable plaque" is changing the way doctors look at cardiac disease[br>
    A Heart's Hidden Danger

    w/Anatomy Of A Killer Illustration

    It is not an uncommon story....,9171,219792,00.html [br>

    Catching A Heart Attack Before It Happens - 9/17/05[br>
    Medical Center uses a new IVUS device that shows doctors what kind of....

    New Laser Speckle Imaging May Identify Deadly Plaques - 8/5/05[br>
    They have been called a ticking time bomb....


    Heart-Healthy Foods

    Avoid foods high in saturated fat and cholesterol. Choose skim or low-fat milk, low-fat yogurt and reduced-fat cheeses. Eat more fish and poultry. Limit servings to five to seven ounces a day. Trim visible fat. Limit egg yolks. Substitute two egg whites for one whole egg or use an egg-substitute. Eat more fruits and vegetables, whole grains, breads and cereals. Use less salt and fat. Season with herbs and spices rather than with sauces, gravies and butter.



    "Be a questioning patient. Talk to your doctor and ask questions. Studies show that patients who ask the most questions, and are most assertive, get the best results. Be vigilant and speak up!"

    - Charles Inlander, People's Medical Society


    It's your there.

    . .
    [br> WebMD/WebMD Health Exchanges does not provide medical advice, diagnosis, or treatment.
    CardiostarUSA1 replied to CardiostarUSA1's response:

    "EKG suggested I had a silent heart attack"

    A routine resting electrocardiogram (ECG/EKG) is an "inexact science", a relatively low-sensitivity 2D recording of a dynamic 3D process, offering limited heart-diagnostics, and sometimes yields inconclusive or erroneous results.


    Heart info, cardiac tests (commonly performed, mainstream types) info, actual diagnostic images


    It is important to remember that EKGs are not 100% accurate. Normal recordings can be obtained in patients with significant heart disease , or some "abnormalities" may exist in the presence of a normal heart.

    Also, l@@king back in the archives at MedHelp, there was a question (a similar question was posted on WebMD as well) posted: If an EKG shows a previous heart attack, why do follow up EKGs don't?

    The answer, which came from a cardiologist at the Cleveland Clinic, was:

    EKG lead position can sometimes show old heart attacks when they in fact never happened. EKGs are not the gold standard for finding old MIs and can show heart attacks where they haven't happened and sometimes miss ones that did. If your cardiologist ran tests and didn't see evidence of an old MI, it probably never happened.


    "Coronary calcium cat scan"

    Going beyond calcium scoring, 64-slice Cardiac CT allows doctors to view/examine the heart and the coronary arteries in never-before-seen detail.

    Far better yet, as reported, the new blazingly fast (benefit of less radiation exposure to the patient, and less contrast media) 320-slice Cardiac CT scanners can measure subtle changes in blood flow, or minute blockages forming in blood vessels, no bigger than the average width of a toothpick (1.5 mm) in the heart, and the brain.

    Robert A Harrington, MD responded:
    Great questions and solid advice given by CardiostarUSA. First, let's talk about the EKG. One reason that doctors use the EKG to look for evidence of a prior heart attack. We look for fairly subtle electrical changes that suggest that a heart attack may have taken place in the past (the electrical signal of the heart passes through dead tissue differently than it does live tissue). But this finding on an EKG is not 100% reliable. The CT scan suggests a low probably of heart blockages but again this is not 100% reliable.

    Most importantly, how do you feel and what are your coronary risk factors? Do you smoke, have diabetes, high blood pressure or high cholesterol? As described in CardiostarUSA's reply, most important is to look at this as an opportunity to think about a heart healthy lifestyle. Heart blockages develop over many years and changes in lifestyle need to be prolonged to make a difference.

    Be healthy and good luck.

    Bob H
    mishelrobertson responded:
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