Symptoms Of A Silent Heart Attack

There are 1,905 deaths from heart disease each day in the United States - or one death every 24 seconds - making heart disease the leading cause of death for both men and women.

That danger is multiplied by the fact that many people don't realize they are having a heart attack when they don't experience the stabbing chest pain or other symptoms people associate with heart disease.

"This is a silent condition most of the time. You want to act when you are still healthy or ‘healthy,’” said Omar Hamoui, MD, cardiothoracic surgeon who chooses to practice at Franciscan Health Olympia Fields. “And when you act before it hits, before it did a heart attack or a stroke, you can prevent 90 plus percent of its consequences"

How Common Are Silent Heart Attacks?

Also called silent ischemia or a silent myocardial infarction, a silent heart attack, or a heart attack that does not have the traditional symptoms, account for 45% of heart attacks and strike men more than women.

Of the estimated 805,000 heart attacks each year in the U.S., one in five are silent heart attacks, according to statistics from the Centers for Disease Control & Prevention and the American Heart Association.

What Are Silent Heart Attack Symptoms?

Symptoms of a silent heart attack can often be confused with other health conditions. Those symptoms include:

• Angina or chest discomfort
• Fatigue
• Shortness of breath
• Heartburn-like symptoms
• Feeling lightheaded
• Prolonged, excessive fatigue
• Feeling like you have a strained muscle in the chest or upper back

It is only later that evidence of a heart attack is discovered when a patient is being examined for another problem using an electrocardiogram or imaging test, such as an echocardiogram or cardiac MRI.

Angina

Typical angina, a type of chest pain caused by reduced blood flow, can be a sign that a heart attack is likely to occur, said Michael Hogan, MD, FACC, cardiologist with Franciscan Physician Network Specialty Clinic Lafayette.

Angina frequently reveals itself through symptoms such as chest discomfort with associated shortness of breath. The discomfort may extend up to the neck and jaw or out to the shoulders. It usually occurs with exertion and will resolve by resting.

However, heart attack symptoms that don’t include chest discomfort are often missed.

Fatigue

Are you feeling more tired than normal? Patients can mistakenly assume the fatigue they are experiencing is due to aging or other factors, but blockages in coronary arteries could be the culprit. When blood flow to the heart muscle is decreased, a person gets tired more easily.

Angela Brittsan, MD, PhD, cardiologist at Franciscan Physician Network Indiana Heart Physicians Indianapolis, says high blood pressure can cause changes in the heart, increasing muscle mass, becoming thicker and increasing risk for congestive heart failure.

"You start to show other signs of heart failure like feet or leg swelling or increased fluid retention in the belly and real significant shortness of breath," she said.

Shortness of Breath

Shortness of breath or trouble breathing while doing small activities can be a symptom of a silent heart attack.

While people may be conscious of symptoms that occur during exertion, Dr. Hamoui said stress and anxiety are other common triggers.

"I want to raise your attention to one aspect of stress and maybe you can do something about it. This is anger. Anger outbursts," he said. “If you get angry a lot, that could be more important than smoking and blood pressure and cholesterol. Do something about it.”

Heartburn-like Symptoms

Dr. Hogan says another symptom is heartburn that can occur with exertion and is associated with shortness of breath.

"A person should expect heart disease or should be concerned if the 'heartburn' does not usually occur around food consumption," Dr. Hogan said.

Feeling Lightheaded

If you break out in a cold sweat, feel nauseated, or feel lightheaded, don't dismiss it as the flu. You could be having a silent heart attack.

How Can I Prevent A Silent Heart Attack?

Now's the time to focus on heart-healthy habits, including stopping smoking or tobacco, eating a healthy diet, managing stress and exercising regularly.

Dr. Brittsan says one of the best preventative measures is having your vital signs checked.

"If you never check your blood pressure, you'll never know it's elevated," she said. Blood pressure numbers of less than 120/80 mm Hg are considered within the normal range, according to the American Heart Association.

Plenty of affordable devices available allow you to check your blood pressure at home. Dr. Brittsan recommends one that uses an arm cuff, making sure it's correctly sized.

For people that have a family history of heart disease, another important test is a heart scan that measures coronary artery calcium to find evidence of plaque disease before a silent heart attack happens.

Dr. Brittsan stresses the importance of consulting your doctor before a heart condition worsens.

"When people say, 'I feel fine and don't need to go to the doctor,' just because you feel fine doesn't necessarily mean you're OK," she said.

Having a silent heart attack increases the risk of heart failure by 35% compared to people without evidence of a heart attack, according to a 2018 study in the Journal of the American College of Cardiology. The risk was even higher in people in their early 50s and younger.

Silent heart attacks also may increase the risk of stroke, based on preliminary research presented earlier this year at the American Stroke Association's virtual International Stroke Conference.

And in the long run, silent heart attacks appear to be just as deadly as diagnosed ones.

A 2018 study in JAMA Cardiology found participants with a silent heart attack fared progressively worse over time. After 10 years, about half of them had died – the same death rate as participants who had a recognized heart attack.

Experts stress the need to educate the public about the more subtle symptoms of a heart attack and to not ignore them. Seeking early medical attention is important.