Silent Myocardial Infarction: A Case Report

Abstract

Silent myocardial infarction (SMI) is a type of myocardial infarction (MI) that is asymptomatic or demonstrates mild symptoms; therefore, patients often do not seek medical treatment. SMI cases are often incidentally detected later by electrocardiogram (ECG). We present a case of a 59-year-old overweight woman with prediabetes, primary hypertension, and hypercholesterolemia who presented for herpes zoster (HZ) follow-up; she reported having skipped heartbeats and heart rate fluctuations during the review of systems. On further workup, ECG revealed low voltage QRS complexes, flat QRS complexes, flat T waves, and pathological Q waves, suggesting the diagnosis of SMI. Based on the identified risk factors, including high BMI, prediabetes, primary hypertension, hypercholesterolemia, HZ, and newly diagnosed SMI, the patient was advised to continue with lisinopril 20 mg daily, prescribed atorvastatin 80 mg daily, and was educated about maintaining a healthy diet, exercise, and receiving the shingles vaccination. To prevent the possible risks of poor outcomes such as those following MI, stroke, heart failure, arrhythmias, angina, and shortness of breath (SOB), the patient was referred to the cardiologist for a stress test and further treatment plan.

Keywords: cad: coronary artery disease; cardiovascular disease (cvd); cardiovascular disease prevention; cardiovascular disease risk; electrocardiogram (ecg/ekg); myocardial infarction; old myocardial infarction; silent myocardial infarction.

Figure 1. ECG of the patient

The image shows small Q waves in leads V2 and V3, Q waves with an amplitude of 4-5 mV in lead III, flat QRS complexes, and flat T waves in lead aVF Green arrows: Q waves in leads V2 and V3. Red arrows: Q waves with an amplitude of more than 2 mV in lead III. Blue arrows: flat QRS complex in lead aVF. Yellow arrows: flat T waves in lead aVF ECG: electrocardiogram