Q: I am 45 years old. Recently I had an episode when I was driving back from helping a neighbour with his horses. I mostly watched and did not do much physical work myself. However, I did not eat all day. When I was driving home I felt nauseous and later, just as I was going to eat supper, I broke out into a cold sweat and then passed out on the floor. I was not completely unconscious as I could hear people talk, but couldn’t speak. I went to the hospital but they couldn’t find any signs of a heart attack. Can you have a heart attack without chest pain? My brothers both suffered from heart attacks at early ages – 42 and 43.
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A: It would be unlikely for you to have a heart attack at this age without having any kind of pain. Sometimes elderly people, usually women, can have what is known as a silent heart attack. This means they do not have the classical chest pain or pain radiating down the left arm, but may have a feeling similar to indigestion. Younger males generally feel a great deal of chest pain.
I think the most likely explanation is that you had an attack of hypoglycemia or low blood sugar, from not eating all day. This can cause a person to have cold sweats, nausea and a slowed pulse rate, which can lead to a fainting spell such as you had.
Do you have a family history of diabetes? Sometimes people with relatives who suffer from diabetes are more likely to have hypoglycemia. It may also mean you could be more prone to developing type 2 diabetes later in life.
It is important to watch your diet and eat regular small meals about every two to three hours. You may need a mid-morning or mid-afternoon snack.
As there is a strong family history of heart attacks at an early age, it would be wise to take some precautions. It is important to keep your cholesterol levels as low as possible. You may need the help of a cholesterol-lowering drug such as Lipitor. Please note that another anti-cholesterol drug, Baycol, has recently been recalled due to dangerous side effects.
Another less widely used preventative measure is to take small doses of an ACE inhibitor. These drugs, for example Renedil, are more often used to treat high blood pressure, but they do also strengthen the heart muscle. Of course, you should make sure to get plenty of exercise, but this alone is not enough to prevent heart attacks. Even marathon runners can still have problems.
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