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“The good news,” Arun explained to her daughter who had just arrived, “is that we’re past the acute danger zone. The heart attack already happened, and she survived it. The bad news is that her heart is weaker now, and we need to find out why she didn’t feel it clearly enough to come in.”

“You couldn’t have known,” he said gently. “But we know now.”

Arun’s mind was already cataloging the implications. An old anterior infarct meant scar tissue. Scar tissue meant the heart had lost some of its contractile power. The ejection fraction could be 40%, 35%, maybe lower. She wasn’t in failure now—her lungs were clear, no edema—but she was a silent time bomb for arrhythmias, for a drop into cardiogenic shock with the next infection or dehydration.

“Did you feel short of breath?”