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Signs and symptoms of a silent heart attack

By Sheisoe
Signs and symptoms of a silent heart attack

What is a silent heart attack?
What are the symptoms of a silent heart attack?
What are the risk factors of a silent heart attack?
Health consequences of a silent heart attack
How to Diagnose a Silent Heart Attack
How to prevent a silent heart attack
References
Read more

A silent heart attack, also called silent myocardial ischemia, is a heart attack without symptoms or with minimal, unrecognizable symptoms. The presence of a silent heart attack is a strong predictor of mortality.

Signs and symptoms of a silent heart attack

Image credits: Indypendenz/Shutterstock.com

What is a silent heart attack?

A silent heart attack is a condition in which blood flow to the heart is reduced due to the buildup of plaque in the arteries. The condition often occurs without causing typical heart attack symptoms, such as chest pain or discomfort, nausea and sweating, and shortness of breath. The condition is associated with 70-80% of transient ischemic episodes. 1

Coronary artery disease is a major risk factor for a silent heart attack, although people with no history of coronary artery disease can also be affected by the condition. 2

Silent heart attack symptoms lack the intensity of classic heart attack symptoms. In other words, the symptoms are so mild and short-lived that they are often mistaken for a regular discomfort or another less serious problem, such as heartburn, gastric reflux, indigestion, or fatigue due to work pressure or lack of sleep. 3

The location of the pain is another crucial factor that is often misunderstood. Unlike a classic heart attack where a sharp pain appears in the left side of the chest, a silent heart attack can cause a mild pain in the center of the chest. 3

In some cases, a silent heart attack occurs without any chest pain, and therefore patients suffering from the condition do not seek medical attention in a timely manner. All these factors contribute to the risk of missing the warning signs and subsequently increase the risk of morbidity and mortality. 3

What are the symptoms of a silent heart attack?

Patients with a silent heart attack may experience mild symptoms or no symptoms at all.

Unlike sudden and intense chest pain felt in classic heart attacks, a silent heart attack is associated with mild pain or discomfort in the center of the chest. People may also feel pressure, squeezing, or fullness in the breast. These symptoms usually appear slowly and then disappear and return. 4

Aside from the chest, people having a silent heart attack may experience mild pain or discomfort in the arms, back, neck, jaw, or stomach. Shortness of breath and dizziness are common symptoms of a silent heart attack that can occur with or without chest pain. 4

Here are signs you may be having a ‘silent’ heart attack

People with silent heart attacks may experience nausea, vomiting and cold sweats. These symptoms are very similar to those that occur with viral infections and should therefore be monitored carefully and attentively. 4

What are the risk factors of a silent heart attack?

The most common risk factor for a silent heart attack is coronary artery disease. Buildup of cholesterol-rich plaque in coronary arteries can restrict blood flow to the heart, which in turn can increase the risk of a silent heart attack. 1

Diabetes is another major risk factor for a silent heart attack. Cardiac autonomic dysfunction, involving pain receptors, afferent neurons, or higher brain regions, is significantly associated with the development of diabetes. In diabetic patients, atherogenic dyslipidemia significantly increases the risk of coronary artery disease and silent heart attack. 1

Other possible risk factors for a silent heart attack include being older, being overweight or obese, having high blood pressure, blood cholesterol or blood glucose, and feeling stressed. People with a previous heart attack or a family history of a heart attack are also at greater risk for a silent heart attack. 5

Eating unhealthy foods loaded with cholesterol, sugar, salt and saturated fat, not getting regular exercise and smoking are some of the major lifestyle risk factors for a silent heart attack. 5

Women with a history of preeclampsia and individuals with a history of coronavirus disease 2019 (COVID-19) are at greater risk for a silent heart attack. 5

Health consequences of a silent heart attack

The health consequences of a silent heart attack depend on the risk factor profiles and comorbidities of the affected patients. Patients with a history of stable angina (a type of chest pain) are at risk of experiencing the worst health consequences. 1

Patients with a documented silent heart attack are at significantly higher risk of cardiac death. In patients without coronary artery disease, a silent heart attack increases the risk of adverse cardiovascular events and mortality. 1

A silent heart attack can increase the risk of heart failure by 35%. The risk is even greater in people under 50 years of age. Some preliminary data suggests that a silent heart attack may increase the risk of stroke. 6

How to Diagnose a Silent Heart Attack

The signs and symptoms of a silent heart attack can be detected during a physical examination. Doctors may suspect a silent heart attack if the patient has a fast or irregular heartbeat. Unusual noise in the lungs is another parameter for suspecting a silent heart attack. 5

Tests commonly performed to diagnose a silent heart attack include blood tests of cardiac biomarkers, electrocardiogram, cardiac catheterization with coronary angiography, computed tomography (CT) scan, magnetic resonance imaging (MRI), exercise stress test, nuclear stress test, and echocardiogram. 5

How to prevent a silent heart attack

The most effective medications to treat a silent heart attack are beta blockers and calcium channel blockers. Antiplatelet drugs, such as aspirin, and lipid-lowering medications, such as statins, are also used to treat silent heart attacks. 1

In patients with coronary artery disease, behavioral stress management therapies have shown beneficial results in terms of improving mental health and preventing silent heart attacks. 1

Coronary artery revascularization is not usually performed solely based on silent symptoms of a heart attack. However, this procedure may produce favorable results in patients with high-risk features, such as ischemia over a large myocardial area. 1

The risk of a silent heart attack can be reduced by considering a number of lifestyle changes, such as eating healthy foods, being physically active, reducing smoking and alcohol consumption, managing stress levels and maintaining a healthy body weight.

References

1. Gul Z, Shams P, Makaryus AN. Silent myocardial ischemia. In: StatPearls. StatPearls Publisher; 2024. Accessed September 20, 2024. http://www.ncbi.nlm.nih.gov/books/NBK536915/

2. CohnPF. Silent ischemia: a current aspect in coronary artery disease. Rev. 1987;12(5):314-317. https://pubmed.ncbi.nlm.nih.gov/3315916/

3. The danger of ‘silent’ heart attacks. Harvard Health. January 1, 2017. Accessed September 20, 2024. https://www.health.harvard.edu/heart-health/the-danger-of-silent-heart-attacks

4. 4 Signs of Silent Heart Attacks – Penn Medicine. Accessed October 5, 2024. https://www.pennmedicine.org/updates/blogs/heart-and-vascular-blog/2022/april/4-silent-heart-attack-signs

5. Does a silent heart attack have symptoms? Cleveland Clinic. Accessed October 5, 2024. https://my.clevelandclinic.org/health/diseases/21630-silent-heart-attack

6. Silent heart attacks are all too common and often overlooked. www.hart.org. Accessed October 5, 2024. https://www.heart.org/en/news/2021/06/23/silent-heart-attacks-all-too-common-and-often-overlooked

Read more

By Sheisoe

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