When the electrocardiogram or EKG was invented, it represented one of the most significant advances in heart healthcare, particularly in managing and diagnosing heart disease. Today, we take this for granted, as we even have watches that act as bona fide, albeit basic, EKGs. Of course, as with most medical devices, EKGs have made lots of technological progress, and from the early days, we now have an evolution known as the 12-lead EKG that can offer even more data about heart health, including whether a patient is having or potentially has had a heart attack.

Note: For the purposes of this article, we will limit the discussion of EKG to its usefulness in determining whether a patient has had a heart attack.

How Effective Is an EKG in Determining if a Patient Has Had a Heart Attack?

The short answer is that any EKG can be useful as an adjunctive test to determine whether someone has had a heart attack. Recent studies have shown that EKGs can detect a prior heart attack, including a silent heart attack, in just over 40% of cases. While this may not seem high, it’s an easy, noninvasive test that requires little effort and time to perform.

Interestingly, while an EKG is not definitive in determining whether a patient has had a heart attack, it is much better at ruling out whether a patient has ever had one. A proper reading of an EKG can tell a trained cardiologist or clinician, with over 80% certainty, that a patient has never had a heart attack before.

What Are the Better Ways of Determining if the Patient Had a Heart Attack?

If a patient believes they have recently had a heart attack, one of the most valuable tools we have is a simple blood test that measures for a protein marker in the blood, troponin, released when heart tissue is damaged – almost exclusively caused by a heart attack when oxygen-rich blood no longer reaches the heart due to the narrowing or occlusion of the coronary arteries.

By measuring the amount of troponin in the blood, we can reliably determine whether the patient had a recent heart attack. However, levels of these proteins begin to spike 12 hours after a heart attack and remain detectable in the bloodstream for about two months afterward. As such, this test is not ideal for active heart attacks or for heart attacks that occurred long ago. For that, a combination of EKG and advanced imaging is suitable.

Advanced Imaging

We have more tools at our disposal to detect the presence of a prior heart attack than ever before. Typically, we use very sensitive and advanced imaging studies to let us know whether there’s any damage to heart tissue consistent with a heart attack. First is Computed Tomography or CT, a progressive x-ray modality that gives visibility into the heart’s soft tissue layers. Second is magnetic resonance imaging (MRI), which offers even more detail of the heart and ancillary structures to see what may be happening.

Important to Remember

Whenever we discuss heart attacks, we must repeat the mantra that not all heart attacks are the same, nor do they always have traditional symptoms. Many heart attacks have few or unusual symptoms that patients would not usually equate with a cardiovascular issue. As such, if you are experiencing any significant or unusual symptoms, speak to your medical team immediately, as this may be a sign of an impending problem. If you believe you’re having an emergency or a heart attack, do not delay in dialing 911 or going to your nearest emergency room.

The Importance of Early Treatment, Even After the Fact

While many patients are shocked to find out that they had a silent heart attack, the next feeling is often relief, thinking that they may have dodged a bullet. To be sure, it’s great that they may not be experiencing significant disability because of their heart attack, but just like any other heart attack, minor or substantial, the risk of a future heart attack is significantly increased, as is the risk of long-term heart failure.

As such, getting early treatment for a silent heart attack is imperative. This may include lifestyle changes, such as improved diet and additional exercise. Specific medications may be prescribed, and some patients may require invasive procedures to correct significant blockages that may cause a future heart attack.

Conclusion

Ultimately, it is critical to monitor your heart health. Visit your cardiologist periodically, as advised, and ensure that you receive appropriate care for any symptoms you may be experiencing.