I have Sinus Bradycardia and probably always have and with no symptoms so all was fine. About 18 months to two years ago (in hindsight) I started to feel unwell with shortness of breath, unexplained cough, extreme fatigue for no real reason, migraines and just feeling quite detached tbh at times. I was sent for a chest x-ray late 2023 which was clear. The shortness of breath seemed to lesson a lot but the other symptoms remained.
Late last year I had a pain in my chest as I was getting ready for bed. I laid down expecting it to go but it didn't. I sat on the edge of the bed expecting it to go but it still didn't. It was like a very tight squeeze to the extent I was thinking I should call my daughter then decided there was nothing she or anyone could do and ignored (with difficulty) but managed to go to sleep. I was quite dismissive as decided it must be a chest infection though I am not sure why!?
It was more then that I had the symptoms noted above and made a GP appt. I was sent for an ECG and on the waiting list for a lung/Spirometery (or similar spelling) test. My ECG was Abnormal and said (in medical terms which I had to Google) that I may have had a heart attack at some point. I wonder if this is what I had that night as I was going to bed.
I was then sent for an Echocardiogram which was mainly normal - the doctor noted one thing but said many have it so not to worry (something about blood getting pulled back in when pumping!?).
I also had (Pro) BNP blood test which was negative - I think that checks to see if you are in actual heart failure.
Very long winded I know (sorry!) - but wondering thoughts on whether what I suffered that night may have been a silent heart attack and anyone who has had one with no other heart issues, if my symptoms sound like someone who is/was recovering from one.
Also, if it was a heart attack, would it have shown in the echocardiogram? I am not surprised the blood test was negative but am surprised the echo was tbh especially as the ECG was abnormal.
I am waiting for the results of a 24hr holter/ECG too but the results are very behind I am told. Would that def show if I have had a heart attack as there's less leads then when you are wired up at the hospital so unsure?
Thank you!
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Guinness_Guinness
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Hi, I have had a similar set/sequence of events. It's difficult not to talk at length in order to explain. No need to apologise.
A bit of background first. Sinus bradycardia with ectopics was picked up in routine GP health check and checked out with a cardiology referral. Exercise test, Holter ECG, said healthy and quite fit (albeit overweight) . Fast forward eight years and a stroke out of the blue ( possibly stress related). Very fortunate to get fast treatment. Holter monitor and echocardiogram found no issues. Fitted with an internal remote ECG recorder operating 25/7/365 which picked up atrial fibrillation, a single event 3 months later. This would potentially explain the stroke as they can develop a clot in the atrium which then travels to the brain very quickly.
Started a health improvement regime. Then while on a Parkrun 13 months ago, collapsed with a sudden cardiac arrest. 6 weeks in hospital for investigations.
Obviously 24/7. Again all the usual tests ECG, basic scans, x rays, echocardiogram and angiogram came back inconclusive. No obvious visible defects. The implanted ECG which was still in me picked up a left ventricular tachycardia - very serious!
So stressed hospital, overstretched cardio team wanted to treat with an implanted defibrillator and discharge without further investigation. The cardiologists were divided, and here's the point. One influential cardiologist asserted I must have had a silent heart attack! I had never had any symptoms before the stroke or SCA or knowingly at any other time, not even the symptoms you have. But other cardiologists including my nominal lead wanted more diagnostics. This was a general hospital and while it could fit pacemakers and ICD's this was the limit of its diagnostics and treatment. So I had to go to Oxford for ba specialist MRI and a subsequent specialist Pet scan.
The MRI showed heart scarring and severe wall thinning of the left ventricle. This hadn't been picked up by any of the other investigations including a routine MRI. While this implied a myocardial infarction it didn't mean it was caused by a heart attack and Oxford suggested further investigations of either an embolic (clot) or non ischaemic (not blood vessels or heart defects) causes.
You are an individual and my symptoms etc are not yours. 90% of heart issues are 'typically' ischaemic related, blocked arteries, plaque break offs , heart attacks. So cardiologists spend most of their investigations looking in this direction and this gives rise to the silent heart attack explanation. They will look at blood samples after an event, and a marker called troponin. After my SCA and before the LVT was found troponin was detected giving rise to the 90% heart attack theory, mine being a silent heart attack because I had no symptoms. My collapse should have suggested different, but with 4 day waits in A&E the desire to send me home was great and after 48 hours I was discharged. Only to receive a telephone call 12 hours later to go straight back, do not drive, prepare to be admitted to cardiology when a bed was available but meanwhile present at A&E. The LVT recording had surfaced. But the difference if opinion in the cardiologists was set.
I am writing this to encourage you to work hard to understand and be ready to ask for clarification and explanation of what all your results, tests etc mean.
If they have indecisions ask if there are more tests they can do. I know I have some fundamental heart issues that I have to live with as a result of appealing to the more curious cardiologists who insisted more tests were needed.
Had I gone home and accepted silent heart attack I wouldn't know how to adapt my lifestyle as I now do. And of course if I have another event, the investigations will have a clear starting point.
And as a final cautionary note I was banned from driving for 8 months in total.
And I will say again 90% of heart related events are cardiovascular related. I am in the 10% group.
Thank you so much for such an informative response - lots to ponder on and consider there - very helpful, much appreciated. I am 57 and not overweight but wouldn't say 'fit' - I have back issues and a lot of metalwork along my spine which restricts me a bit but I try doing stretches and walk a lot. I feel I am being told sometimes that sinus bradycardia can be an indication of a fit person and see me as not overweight and under 60 and never smoked but I am not 'fit', have an unexplained cough, shortness of breath, migraines, lightheaded, exhausted for no reason too but some days worse than others but for a few weeks after what may have been a silent heart attack.....just wish I knew for sure......wish I'd gone to hospital but you fear the queues and feeling like there's nothing wrong if others are spilling blood.
No , it might not show on ECG. I had an nstemi heart attack July 2023. I thought I had trapped wind , stabbing pain in the middle of my chest , very painful. My wife called 111 , they asked me loads of questions and they sent an ambulance/paramedics .They carried out ECG at home and said “ your ECG is fine , whatever has happened has passed .” They were very insistent that I went into hospital with them to have a blood troponin test (enzyme secreted by body after a cardiac event) that would confirm if I had a a heart attack. They says they couldn’t make me go .. I just thought it was sensible and felt a responsibility to clear the matter up as I was adamant it was trapped wind . How wrong was I 🤦🏼. First troponin test came back 74 and second one 402 confirmed heart attack. Angiogram next day , stents not possible, I ended up with quadruple bypass surgery.
Wow, yes I have heard of people mistaking it for indigestion too. My ECG result was the opposite. I was told the blood test you had can only be done at A&E and is the only sure way of knowing. Had I been aware of possible heart issues then I would of course have definitely gone to A&E. I hope things have improved some for you.
👍🏻 made a fantastic recovery , back to running 5k 2-3 times a week , swimming 2-3 times a week, physical work round our small holding, chipping away at goals & bucket list, riding motorbikes , living life to the full 👊🏻👊🏻👊🏻
Like you it looks like I’ve been sinus Bradicardic all my life (now 64) over last 15 months I’ve learnt so much and all the signs I know now I can relate to my first symptoms when I was about 11. I have low blood pressure blood group O-negative. sleeping HR 42 resting HR 56. After exercise and stress makes my HR drop to low 30s
Everything came to a head January 24. Breathless light headed. Struggled to breath exhausted, fatigue. Tests/ECGs showed I’d become Tachy/Bradicardic.AFib, Arrythmia. Arterial flutter. HR 23-184.
I’ve had cardio version Jan 24 - lasted 11 days. April 24 had cardio Ablation in right atrium ( some success) Jan 25 had cardio Ablation in left atrium managed to give me a regular heart rate of 73/74 for the first time (sadly it only lasted 2 1/2 days) they also found 2 lots of unexpected scar tissue, (which means I’ve had a heart attack sometime in the past without knowing)then heart went Tachycardic again HR 150+. Last 24hr ECG showed AFib 479 times in 23 hrs and HR went 209 BPM 4 times. Feb 25 they tried cardio version again and laser only 15 minutes. All my blood tests keep coming back normal over last 15 months. Treponin is the one that tells you if you’ve had a heart attack if above 50/55 it’s signs of heart attack mine are 14-16.
Aug 24 had the world’s smallest most accurate cardiac monitor implant injected into my chest as my heart is so screwed up. It’s the length of AAA battery and 1/3 diameter. Linked via App on my phone live to my hospital and is monitored 24/7.
The only thing l can poss relate to may be my heart attack June 2019 had a very physical working day. A very stressful letter in the post. 10pm I stood up to take an empty glass to the kitchen. I collapsed, almost passed out, fell on the glass, took half my face off, amputated my nose, lost 4 pints of blood, paramedics arrived in 4 minutes otherwise outcome would have been different. (Heart went Bradicardic) Paramedics, doctors, plastic surgeons all asked my why my HR was so low - 25-50 BPM. Did I do a lot of exercise. I’d been going to gym 3-4 times a week and was the most fit I’d ever been. I joined a gym because I’d been feeling so tired fatigued, etc. I’d spend 1hr on Cross trainer and then do weights afterwards then would start to fall asleep on the bench (Bradicardic)
I’m medication intolerant so every heart med they have tried (now on no 6) what ever the dose some have been given 10-15 times the max dose and absolutely nothing has happened. Blood thinners Apixaban make me breathless, fatigue, keep falling a sleep if I sit down.
Currently waiting for urgent 3rd Ablation again in left atrium. Using new tech - Optrell mapping catheters. Only approved for use Oct 24. All computerised and have shown a better success rate in trials for complex cases. We are fast running out of options 😩
Good luck. Wish you all the best. Happy to chat if you need to.
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