A lot of the population, through health education on radio and television stations, some health content on social media, wand atching movies on television, perceive Heart Attack as only a crushing chest pain that should let them get to the health facility or emergency department for check-up.

For Medical Doctors, Clinicians and Health Care Practitioners, Myocardial Infarction (MI) is the clinical or medical name of the condition, and Heart Attack becomes the common name easily to go with for the ordinary person's understanding.  The basic understanding of a myocardial infarction or Heart Attack is that it occurs when the flow of blood to the heart is severely reduced or blocked.

This blockage is usually due to a build-up of fat, cholesterol and other substances in the heart (coronary) arteries. The fatty, cholesterol-containing deposits are called plaques. The process of plaque build-up is called atherosclerosis. Sometimes, a plaque can rupture and form a clot that blocks blood flow. A lack of blood flow can damage or destroy part of the heart muscle.

In diabetics or people suffering from diabetes, Heart Attacks can be silent or have atypical symptoms to the extent that there can be little to no chest pain at all. In diabetics, this can make the cardinal known symptom of crushing chest pain become only a perception but not a reality in most cases and is at times missed by Health Care Practitioners. This then becomes dangerous because treatment is most effective when signs, symptoms and diagnoses are seen early.

Heart Attack in diabetics is not truly symptom-free in many cases; symptoms are often subtle or non-chest symptoms. For diabetic patients, there is a high chance of a reduction in crushing chest pain or no chest pain at all due to nerve damage (diabetic neuropathy) that blunts the pain signals.

Long-term high blood sugar without effective medical control can damage nerves, including the nerves that carry pain from the heart, and this usually leads to a condition termed cardiac autonomic neuropathy. As a result of this, the heart can suffer severe consequences without clear signals because the “alarm system” is now weaker. Diabetes mellitus, when not medically managed early enough, damages blood vessels. Diabetes accelerates atherosclerosis (plaque build-up).

Many people develop multi-vessel disease and “silent ischemia” (low oxygen to the heart muscle without pain).  

In conclusion, diabetes can damage nerves and blood vessels, which can make heart attacks less painful and easier to miss.

 It is worth noting that people who suffer from diabetes and who suddenly experience breathlessness, sweating, nausea, jaw/arm/back discomfort, or extreme fatigue, may have potential Heart Attack warning signs without the accepted crushing chest pain and should quickly report to emergency departments to see medical doctors for further assessment and management before the worst happens.

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The author, Richard Owusu Nyarko, M.D., PhD, Ph.D is a Medical Doctor, Academic Researcher & Member of the American Heart Association and Vice President, Ghana Christian University College, Accra.