Question:

At my last physical, my doctor said that my EKG showed that I may have had a heart attack sometime in the past. How could that be? Wouldn't you think I'd know if I have had a heart attack?

Answer: We're all familiar with the classic chest pain symptoms: a tightness in the center of the chest lasting more than a few minutes; radiation of the pain into the left arm, shoulder or the neck; and associated shortness of breath, sweating, or nausea.

But that's not always the way it happens. Sometimes instead of chest pain or pressure, a person having a heart attack will have abdominal pain and nausea that mimics a bout of indigestion or a stomach "bug."

Sometimes there's no chest pain at all, with only palpitations and cold sweats.

Sometimes there's unexplained shortness of breath without an obvious cough or fever or chest infection. Sometimes there's just an unexplained weak feeling.

As many as 30 percent of those who have heart attacks have "silent" ones, either not feeling any discomfort at all or simply attributing non-typical symptoms to something else. Some folks may mistakenly treat their non-typical heart attack symptoms with antacids, pain relievers, and rest. They are just lucky in surviving a heart attack that only becomes apparent when a routine EKG reveals it.

It's best to follow the EKG with an echocardiogram (sonogram) of the heart to see if there are any areas of the heart that aren't moving or move weakly.

EKGs sometimes falsely indicate that you may have had a heart attack. A cardiologist may recommend a nuclear stress test to check things out further.

Regardless of how things turn out, it's a good thing to address any risk factors that might predispose you to getting heart disease. If your cholesterol is high, try to lower it through diet and keep it down. If that's not working, talk with your doctor about lowering it with a drug like Lipitor or Zocor. I'd also recommend asking your doctor about starting an aspirin a day.

It will help decrease the risk of clots and may prevent a heart attack.

I'd also recommend taking fish oil capsules. If you're smoking, obviously you need to quit. If you're a diabetic, get your sugars under good control.

Mitchell Hecht specializes in internal medicine. Send questions to him at: "Ask Dr. H.," Box 767787, Atlanta, Ga. 30076. Because of to the large volume of mail received, personal replies are not possible.