Edinburgh scientists discover 'hidden heart disease' in heart scan that could lead to change in NHS guidelines

Heart imaging techniques already available on the NHS could be used to improve detection of underlying heart disease and treatment following a heart attack according to research from scientists at the University of Edinburgh

The research, funded by the British Heart Foundation found that performing a combination of heart scans on patients who are suspected of having a type 2 heart attack can drastically increase diagnosis of underlying heart conditions, opening the door to immediate treatments that could prevent a second heart attack.

A ‘traditional’ (or type 1) heart attack happens when one of the small arteries supplying blood to the heart becomes blocked, which starves the heart muscle of oxygen and nutrients, and leads to damage.

However, a type 2 heart attack – which accounts for 15 per cent of patients with damage to their heart 2 - does not involve a blockage. It occurs with illnesses that put the body under stress and when the oxygen being breathed in cannot meet the demands of the heart. This puts the heart under additional strain and can happen with conditions such as pneumonia, heart rhythm problems, or very low blood pressure.

In the first study testing heart imaging techniques in type 2 heart attack patients, scientists at the University of Edinburgh have found that performing a combination of heart scans on patients who are suspected of having a type 2 heart attack can drastically increase diagnosis of underlying heart conditions

Currently, there are no guidelines for doctors on how to best assess or treat a patient after they are diagnosed with a type 2 heart attack meaning that most people who have one do not undergo further testing or treatment, with only around a third of patients surviving after five years.

Researchers looked at the results of different heart scans of 100 people who had been diagnosed with a type 2 heart attack and analysed the blood vessels in the heart, and heart MRI scans to look at the structure and function of the heart in real-time.

Two thirds of patients were found to have coronary artery disease, and one third were found to have heart muscle weakness, both conditions that are easily treatable.

Over 50 patients were given a new diagnosis, and seven were re-diagnosed as having had a ‘traditional’ heart attack following the study.

The team already plan to start a clinical trial to further look at patient outcomes after performing a combination of angiogram and echocardiogram scans in patients with type 2 heart attacks with hopes of expanding to an international trial.

Dr Andrew Chapman, BHF-funded researcher at the University of Edinburgh who led the study, said: “We’ve provided much-needed evidence that heart imaging tools already available in hospitals can spot hidden heart conditions in people with this type of heart attack that we now know is common but often overlooked.

"These conditions can be easily treated once identified and we hope these results, combined with our upcoming clinical trial, will bring us closer to the first guidelines for diagnosis and treatment of a type 2 heart attack.”

Professor Sir Nilesh Samani, Medical Director at the British Heart Foundation said: “Thankfully, more people than ever are surviving heart attacks. However, survival rates for a type 2 heart attack are much lower than a traditional heart attack.

"We urgently need new guidance for doctors on how to assess and treat these patients, which this research provides. This is a vital step towards helping people make a better recovery and reduce their risk of a second heart attack, heart failure and even death.”