“Silent” heart attacks – more common than we think

Here’s a rather scary fact: About 45% of all heart attacks occur without you even knowing it, striking men more than women.  Unlike the stark contrast to what most of us assume a heart attack will look like – a person clutching their chest writhing in agony – a silent heart attack can happen without you knowing it.  

Silent heart attacks, also known as silent myocardial infaction (SMI), account for almost half (45%) of heart attacks according to research from the Atherosclerosis Risk in Communities (ARIC) study.   We take it for granted we’ll know it’s a heart attack if we have one but in reality, heart attacks are not always so easy to diagnosis.  This is why understanding what a silent heart attack is and symptoms associated with them is important to be aware of.

The name “silent” heart attack comes from the fact that many people who have one will have no idea they did.  Silent heart attacks lack the symptoms of a classic heart attack – extreme chest pain and pressure, stabbing pain in the arm, neck, or jaw; sudden shortness of breath, sweating, and dizziness.  

But don’t believe a silent heart attack is just a minor issue that will pass.  Having a silent heart attack is a major warning bell ringing but can’t be heard signaling that there are serious underlying health issues needing attention.

Symptoms of a silent heart attack

Symptoms of a silent heart attack are often so mild and brief that they are easily confused with a much less serious problem or discomfort to where a person will probably ignore the feelings.  Some warning signs of a silent heart attack can include the following:

  • Discomfort in the center of the chest that lasts several minutes, or goes away and comes back.  It can feel like an uncomfortable pressure, squeezing, or pain.
  • Discomfort in other upper-body areas such as one or both arms, the back, the neck, the jaw, or the stomach.
  • Shortness of breath before or during chest discomfort.
  • Breaking out in a cold sweat, or feeling nauseated or lightheaded.

Other symptoms a person may experience can include general overall fatigue, poor sleep, a general age-related ache or pain, a mild pain in the throat or chest which may be confused with gastric reflux, indigestion, and heartburn.

Another issue of knowing if one has had a silent heart attack is that any pain that may accompany one is often felt in the center of the chest rather than on the left side of the chest which most people associate with a heart attack.  It is also possible that a person will feel completely normal when having a silent heart attack and could easily miss any warning signs that may occur afterwards.

Dangers of silent heart attacks

It would make sense that due to the nature of a silent heart attack, many people will be completely caught off guard when they are told they had one.  This was discovered in a study appearing in the Journal of the American Medical Association that looked at close to 2000 individuals between the ages of 45 to 84 who did not have cardiovascular disease.  

The individuals were followed for 10 years which at the end, 8% had myocardial scars indicative of a heart attack but only 20% were even aware  of their condition.  It was also discovered that the prevalence of myocardial scars were five times higher in men than in women.

This is concerning as even though silent heart attacks may not have the drama associated with them when they occur like a regular heart attack, they can and do leave scarring which damages the heart.  Because most people are unaware they have had a silent heart attack, most do not seek immediate medical care which increases a person’s risk of having another and potentially more harmful heart attack.  

For those who have had a silent heart attack but were not aware they had one and therefore did not seek treatment, they are at a three times greater risk of dying from coronary heart disease.  

Getting checked out for a silent heart attack

Often the main reason why a person may eventually go seek help from their doctor is if they are having persistent symptoms of fatigue, shortness of breath, or heartburn.  They most likely are not thinking it has anything to do with having had a heart attack.  But if one is experiencing such symptoms or any others that are out of the ordinary, they need to go to their doctor as soon as possible.  Waiting to see if the symptoms go away or thinking they are not that serious, is the wrong thing to do.  To avoid risking a major heart attack, it is better to play it safe getting the symptoms checked out right away.  

A silent heart attack can usually be detected from an electrocardiogram (EKG) or echocardiogram which can identity damage to the heart muscle.  There is also a blood test often used in hospital emergency rooms when a person comes in with heart attack symptoms for the molecular footprints of troponin T, a protein released by injured heart cells.  

Treatment for a silent heart attack is the same as for a regular heart attack. The goal is to restore blood flow through the coronary arteries which have become blocked by the buildup of fatty deposits known as atherosclerosis.  Lifestyle changes will be recommended such as eating a healthier diet, losing weight, and increasing exercise along with possible medication treatments of beta blockers or anticoagulants.  Wearing a Holter Monitor for a 24-48 hour period checking for any more episodes of a silent heart attack may also be recommended.  There is the possibility that surgery such as coronary angioplasty followed by cardiac rehabilitation may be required.  

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911. 


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