Note from a reader named Alexandra a few weeks back (links added by me):

Dear Amy,

Silent heart attacks seem to be in a zone of silence -- not nearly enough people know about this in relation to diabetes.

Diabetics have an especially high rate of these painless heart attacks. They may end up with severelyHuman_heart_model_2 damaged hearts and in heart failure without knowing it.  Pre-diabetics may be at risk as well.

I have a personal concern about this topic because my father had Type 2 and he died from heart failure brought on by a series of painless heart attacks. His brother also a diabetic had died suddenly from a heart attack 2 months earlier -- after passing his annual physical exam.

Some years ago, I was a juror on a medical malpractice trial. They did not ask us if any of us had diabetes or knew anyone with diabetes. I was sworn in and seated in the box before learning that the plaintiff had type 2 diabetes. He and his wife either did not seek treatment or his physician had failed to educate him about the urgency of the matter. This man ignored his condition, felt fine, and one day was in a car crash.

He was given a chest X ray in the ER and his heart looked abnormal. He was referred to a cardiologist.  Upshot was that he had had a series of painless heart attacks and his heart was so damaged that he was in Grade III heart failure -- and the treatment of choice was a heart transplant. This man was only 42.

I try to tell people that if they are diagnosed with either diabetes or prediabetes, they should demand to be evaluated by a cardiologist in case they have begun to develop arteriosclerosis -- especially important to do before beginning an exercise program.

Thanks for your blog!

-- AK

A great reminder to think on our heart health.  Who saw the recent NY Times feature, "Lessons of Heart Disease, Learned and Ignored"?  Page 3 notes that "Patients with diabetes might have no obvious symptoms at all other than sudden, extreme fatigue. It's not clear why diabetics often have these so-called silent heart attacks — one hypothesis attributes it to damage diabetes can cause to nerves that carry pain signals."

The director of coronary care at Brigham & Women's Hospital, Dr. Elliott Antman, is quoted:  "I say to patients, 'Be alert to the possibility that you may be short of breath.'  Every day you walk down your driveway to go to your mailbox. If you discover one day that you can only walk halfway there, you are so fatigued that you can't walk another foot, I want to hear about that. You might be having a heart attack."

If you don't believe him, read Alexandra's plea above again.  Pay attention to your state of being, get a little educated, and insist on that treadmill test!  Better safe than sorry, right?  We've already got the diabetes... so let's try to leave it at that.

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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.