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Physicians, providers, and administrative staff who practice at Maui Health hospitals and clinics answer questions from the public in "Healthwise Maui," which appears in The Maui News. Maui Health operates Maui Memorial Medical Center, Maui Memorial Medical Center Outpatient Clinic, Kula Hospital & Clinic and Lana'i Community Hospital and accepts all patients. To submit a question, go to the website at mauihealth.org/healthwise.
Q: My friend had a "silent" heart attack with no chest pain. How is that possible -- and how can I make sure it doesn't happen to me?
Teresa Schulze, NP, Cardiology, Pacific Permanente Group: When most people picture a heart attack, they think of sudden, crushing chest pain along with shortness of breath, dizziness, or a cold sweat. But not all heart attacks look like this. Some have symptoms that are mild, unusual, or easy to dismiss. These are often called silent heart attacks.
According to the American Heart Association, about one in five heart attacks may be silent. They are more common in women, older adults, and people with diabetes, partly because nerve damage or different symptom patterns can reduce pain signals.
In some cases, there are no symptoms at all. Other times, the signs can be vague, such as indigestion, fatigue, nausea, shortness of breath, or discomfort in the jaw, back, shoulder, or arm. Many people mistake these symptoms for stress, illness, or muscle strain and do not seek care.
Some people only learn they had a heart attack later, when heart damage appears on an EKG or imaging test done for another reason.
Silent heart attacks are still serious. They can cause the same level of heart muscle damage as a typical heart attack. When blood flow and oxygen are blocked, the heart muscle may not fully recover. This increases the risk of future heart attacks, heart failure, abnormal heart rhythms, and stroke.
The most important step is to listen to your body. If something feels off, especially new or unexplained symptoms above the waist, seek medical care right away. Early treatment can reduce damage and save lives.
You can also lower your risk by taking care of your heart daily. Stay active in ways that fit your lifestyle, such as walking, swimming, or working in the yard. Eat a heart-healthy diet with fruits, vegetables, fish, and whole foods, while limiting processed and high-salt items.
Good sleep, avoiding tobacco, and managing stress also play a role. Spending time outdoors, staying connected to others, and practicing mindfulness can support heart health.
Work with your doctor to manage conditions like high blood pressure, high cholesterol, and diabetes, which increase risk over time. Medications can help when needed.
At Maui Health, our cardiology team provides advanced heart care close to home. To schedule an appointment, call the Maui Memorial Medical Center Outpatient Clinic at 808-442-5700.
Q: How can I avoid joint replacement surgery?
Dr. Vic Ayers, Orthopedic Surgeon, Pacific Permanente Group: If you're living with joint pain, you're not alone. It can make everyday activities like climbing stairs or walking to the mailbox feel difficult. Whether your pain is caused by arthritis, an old injury, or years of wear and tear, it can affect your mobility, activity level, and overall quality of life.
While joint replacement surgery can be helpful in some cases, it's usually not the first step. There are many non-surgical options that can reduce pain, protect your joints, and potentially help you avoid surgery.
One of the most effective ways to reduce joint strain, especially in the knees, is maintaining a healthy weight. Even modest weight loss can make a noticeable difference. Pair that with regular, low-impact exercise like walking, swimming, or biking to stay active without putting excess stress on your joints.
Building strength is also key. Strong muscles support and stabilize your joints. Exercises like leg lifts, curls, and resistance training, even with simple bands, can improve joint function. Stretching is just as important, as tight muscles can increase discomfort. A physical therapist can help you develop a safe, personalized exercise plan.
Another important but often overlooked factor is smoking. Quitting smoking can reduce inflammation, improve circulation, and help medications work more effectively. It also protects cartilage and bone health over time.
Over-the-counter medications like acetaminophen or ibuprofen can help relieve pain and inflammation. Some people also try supplements like glucosamine or chondroitin, though it's important to talk with your doctor before starting any new treatment.
Other non-surgical options include injections, such as cortisone or hyaluronic acid, which may provide temporary relief. In some cases, minimally invasive arthroscopic procedures can address joint damage and delay or prevent the need for full joint replacement.
If surgery does become necessary, it's important to know that you have options and support. Joint replacement is a major decision, but it can significantly improve quality of life for the right patient.
Maui Health offers comprehensive orthopedic care with a team of specialists who are part of the local community. Patients have access to both non-surgical treatments and advanced surgical options close to home.
To learn more, you can attend a free Total Joint Seminar held monthly in Wailuku or explore more about our Total Joint program on this page. For those considering next steps, you can also call the Maui Memorial Medical Center Outpatient Clinic at 808-442-5951.
Let's work together to keep you moving, active, and living well.