March 12, 2006
In the Feb 14 issue of the European Heart Journal, investigators from Rotterdam (the Netherlands) report that 43% of myocardial infarctions (heart attacks) that had occurred in a population of 4187 subjects had not been recognized by either the patient or their doctors.
This data comes from the population-based Rotterdam Study. Individuals followed in this study had baseline ECGs performed between 1990 and 1993. Follow-up ECGs were performed in 1994-1995 and in 1997- 2000. Of these patients, 141 were known to have had myocardial infarctions. However, an additional 89 cases of previously unrecognized myocardial infarctions were discovered on the follow-up ECGs. Thus, 43% of myocardial infarctions had not been diagnosed or recognized at the time they occurred. Even more disturbing was the fact that, among the women included in this study, a full 54% of myocardial infarctions had been unrecognized.
The authors of the study could not explain why the incidence of undiagnosed myocardial infarctions in this study was so high.
DrRich comments:
Previous population studies have shown a fairly wide variability in the incidence of unrecognized myocardial infarctions, with the most widely quoted statistics being between 20 - 30%. This this latest study reports values that are substantially higher than that.
There are several possible reasons for the high incidence of unrecognized heart attacks. They all boil down to two possible contributing factors: 1) Patients may not be recognizing the symptoms of myocardial infarction, or minimizing their severity (up to 25% of heart attacks are known to occur with relatively minimal symptoms); 2) Doctors may be failing to diagnose myocardial infarction when it occurs.
DrRich does not know enough about the health care system in the Netherlands to say whether patients are actively or tacitly discouraged from going to the doctor for anything but severe problems, or whether doctors are actively or tacitly encouraged not to look too carefully for significant disease when a patient's symptoms seem only moderate - but such things are known to happen in almost any health care system, including America's.
But unrecognized heart attacks do permanently damage the heart muscle, and often lead to heart failure, disability, and early death. On the other hand, when a myocardial infarction is diagnosed in a timely manner, the permanent damage can often be prevented. It is important to recognize the possible symptoms of heart attack, and to get medical help immediately if you suspect that one might be occurring. Here is an article on what to do if you think you are having a heart attack. Women especially need to pay attention to the possible symptoms of a heart attack, since symptoms in women are often not "typical." Here is an article especially for women on when to seek medical help.
