Harold L. Karpman MD - The New Science of Fighting Silent Heart Disease

THE NEW SCIENCE OF FIGHTING SILENT HEART DISEASE

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To my wife, Molinda, for her encouragement, support, and creative contributions

E very minute of every day, thousands of people are walking around with the equivalent of a hidden time bomb ticking away in their chests. Silently, painlessly, their hearts are being injured by repeated interruptions of the vital, nourishing flow of blood through the coronary arteries to the heart itself. As time goes by, the heart sustains more and more damage but there is still no pain until the fateful moment when this process all too often reaches its deadly, unexpected conclusion in a massive heart attack or even sudden death.

While scourges like deaths from drug overdoses and Alzheimers capture the medias and the publics attention, the cold, hard fact of the matter is that heart disease remains the number one killer of American adultsresponsible for five times the number of deaths from drug overdoses and Alzheimers combined. When calculated with the related medical condition known as stroke, cardiovascular disease felled nearly 850,000 U.S. residents in 2017, accounting for one in every three deaths. Cardiovascular disease claims more lives each year than all forms of cancer and chronic respiratory diseases.

About half of all heart attacks are mistaken for less serious problems or completely missed. But make no mistake: silent heart attacks can increase your risk of dying from coronary heart disease.

Silent myocardial ischemia (SMI), or silent heart disease, is a particularly insidious form of the disease suffered by 25 percent of those with heart conditions. As the name implies, patients suffering from silent heart disease are not aware that their heart is being injured because they feel no pain (or not enough to be concerned). Despite undeniable evidence and decades of research, not to mention new diagnostic tools, the perception by the public and, Im sorry to say, many members of the medical profession is that unless less theres chest pain (angina), then theres no heart attack or damage to the heart.

In 1970, I broke with the medical orthodoxy of the time that said that unless a heart attack was accompanied by chest pains, it really wasnt a heart attack, and patients and their doctors need not be concerned. My experience as a practicing cardiologist, the cofounder of a cardiology practice in Beverly Hills, California, and a clinical professor at UCLAs school of medicine told me otherwise.

Two years earlier, my two partners, Drs. Daniel and Selvyn Bleifer, and I had purchased an early diagnostic machine, the Holter electrocardiograph, which used magnetic tape to record electrical cardio impulses through the human body. It weighed eighty-five pounds, but it was state of the art at the time and, most importantly, ushered in a whole new dimension in cardiology. Instead of just examining the heart with the standard electrocardiogram for a period of one minutehardly adequate for a comprehensive evaluationthe Holter equipment permitted evaluation of up to twenty-four hours of heart action. The patients heart now could be studied in the patients home or office, not just in the doctors examination room or medical lab. It was the precursor to todays wearable health devices.

We could now evaluate the effects of stress or ordinary living and working activities on heart action and coronary artery blood flow. Getting this information was vitally important since 95 percent of all heart attacks are caused by restriction of blood flow in the hearts arteries, typically caused by the buildup of plaque or various substances, notably the waxy, organic stuff called cholesterol.

Based on our new research using the new and improved diagnostics, as well as our own clinical observation over twenty years, we were pretty sure that the old trope that a heart attack must be accompanied by chest pain (otherwise, it was not a heart attack) was dead wrong. In September 1970, we presented our research findings at the Sixth World Congress of Cardiology in London, attended by thousands of the worlds leading heart doctors. In a paper titled Clinical Applications of Dynamic Electrocardiography, we proved conclusively that our suspected silent heart disease was in fact a real condition likely suffered by tens of millions of unknowing adults worldwide.

Then we waited for the accolades to pour in for what was obviously our groundbreaking work. They didnt. The reaction among the cardiology profession was more a trickle of acknowledgment than a tidal wave of acceptance.

As it turns out, most physicians were wholly unfamiliar with the development of the then modern-day diagnostic equipment, since the Holter had been in use for only two to three years before the conference and in widely scattered medical facilities at that. For the average physician attending the event, we might as well have been saying that our friends on Mars had beamed the information to us. To be clear, relatively few cardiologists were convinced the newfangled electrocardiograph equipment was significant, and still fewer believed in our hypothesized silent heart disease.

Essentially, the no pain, no heart attack school won the day. The battle, yes, but not the war.

Over the next seven years, the Holter and other electrocardiographic recording devices became more prevalent and more sophisticated. Additional studies by Drs. Daniel Tzivone and Shlomo Stern in Israel in 1974 suggested these painless episodes of poor coronary artery blood flow could occur even during resting activitiesanother heresy, since it was widely believed that strenuous activity was usually a precursor to a heart attack. Imagine, then, if significant and even life-threatening heart damage was occurring all the time while patients were relaxing and with no indication of any chest pain. Impossible!

However, year after year additional studies confirmed our earlier research, including one in 1977 by Drs. Steven Schange and Carl Pepine from the University of Florida, which confirmed that as many as four episodes of silent heart disease occur for every episode of chest pain. You see, it was not an either/or propositionangina or silent ischemiabut oftentimes both.