From CBS News:

How do you treat something that has no symptoms and goes undetected on standard screenings?

DE-CMR (delayed enhancement cardio magnetic resonance) is a new cardiac imaging technique that can detect if you’ve suffered a silent heat attack, which an earlier EKG might have missed.

Early Show medical correspondent Dr. Jennifer Ashton shared this new method of detection with Early Show co-anchor Julie Chen.

According to Ashton, a silent heart attack is “both silent and potentially deadly,” which is “very scary” because there are no typical signs like chest pain or shortness of breath.

“You as a patient might be unaware that you’re having one and it doesn’t leave its signature on the EKG after the fact so your doctor might not be able to tell that you’ve had one,” she explained.

That is all changing now, she says, due to a recent study from Duke University. The study is using an MRI technology, “which has been around for a while, to actually get a picture of the damaged heart muscle, so we might be able to pick this up earlier.”

The MRI technology, although not inexpensive, will be used in a new way.

“Well, for something to be considered a good screening test it really needs to be cheap, it needs to be fast, and it needs to be easily accessible,” Ashton said. “MRI is really none of those things. But it is accurate. So I think that cardiologists are going to be looking more in the future as to how they’re going to incorporate this and amongst what subset of patients.”

This is something that always concerns me. There have been times I have lasted over 16 minutes on a stress test with no angina and failed the test. Subsequent angiograms indicated up to a 98% blockage in one case. However, I also have to be skeptical. As one of the cardiologists I visited recently informed me, if I had pain in the past during any blockages, chances are my neurological system as far as my heart is concerned is intact and functioning. He called into question the need for even an angiogram in this case, thereby implicitly questioning whether there existed a 98% blockage to begin with.

Of course, this conclusion implies my original cardiologist is doing something unethical, which I personally do not believe. He comes recommended by many doctors from various specialties, some of them sending family members to him who are having heart issues. As one of the later cardiologists commented, “Yep, that many stents is typical of patients who see your cardiologist”. He elaborated that, in Austin at least, about 1% of cardiologists will stent you all day long, 1% will never stent you and send you for bypass surgery, and the other 98% will try drug therapy and lifestyle changes before making the decision. At this time, the debate still rages on about how much stenting is too much. I am beginning to lean towards the drug, exercise, and diet approach just because of the wisdom of the body.

While I am alive today because of my original cardiologist, I am also alive because my heart collateralized to the apex from the PDA to the LAD artery. My LAD artery was 100% blocked along most of its length. I should have died, but my body intervened.

Still, one has to worry about these silent heart attacks. I don’t believe the pathology and mechanisms are truly understood and it is prudent that all sufferers of heart disease are aware of this possibility. It is also why it it so important to comply with medical dosing and frequency, and make improvements in your lifestyle.