‘Silent’ Heart Attacks: What You Need to Know

The thought of someone having a heart attack typically brings to mind a picture of a man or woman clutching his or her chest in pain. However, nearly half of all heart attacks may be “silent” – occurring without any symptoms – according to new research published in the American Heart Association’s (AHA) journal Circulation.

Because the warning signs can be very subtle or go unrecognized, people who suffer a silent heart attack have a three-times higher chance of dying from it, compared to those who have typical symptoms. And while silent heart attacks are more common in men, women are more likely to die from one, the study found.

“Women, in general, have more atypical heart attack symptoms than men so they are more at risk for a ‘silent’ heart attack,” says Curtis Hamburg, M.D., a cardiologist with Miami Cardiac & Vascular Institute. “But anyone with heart disease or risk factors for it – even if they have had no symptoms – needs to be closely followed by a physician.”

The researchers studied more than 9,000 adults who already were being analyzed for the causes and effects of having hardening of the arteries. Over a nine year period, 317 participants had silent heart attacks, while 386 had heart attacks with clinical symptoms.

Mild Symptoms Linked to ‘Silent’ Heart Attacks

Among the most common symptoms of a heart attack are pain or pressure in the chest, shortness of breath and breaking out in a cold sweat. In contrast, a person having a silent heart attack is more likely to experience non-traditional, vague indicators, such as unexplained fatigue, an upset stomach or pain in the throat, neck or jaw. These symptoms are often so mild that they are barely noticed as characteristics of a heart attack.

“Anytime someone becomes out of breath for no apparent reason, breaks out in a cold sweat while at the same time is feeling generally fatigued, needs to seek medical attention,” Dr. Hamburg said. “Getting help early can often minimize the size of a heart attack and its potential after effects.”

To achieve the best outcomes, the American Heart Association recommends heart attack treatment begin within one hour after the first symptom occurs. Treatment that’s delayed just 15 minutes later can shorten the person’s life expectancy.

Consequences of not receiving any or timely care for a heart attack include a weaker and less functioning heart and an increased risk of sudden death, according to Dr. Hamburg. Treatment most commonly involves catheterization to check for blocked arteries, as well as controlling risk factors – keeping blood pressure, cholesterol and weight low are among them – to avoid having future cardiovascular events.

People with diabetes are among those at highest risk for a silent heart attack. Neuropathic problems from the disease leave them unable to feel pain, such as chest pain, Dr. Hamburg explains. And anyone who has a silent heart attack is automatically more at risk to suffer additional heart attacks, he adds.

“The best outcomes are achieved only if doctors have an opportunity to open clogged arteries, preserve heart function and prevent more damage in the future,” Dr. Hamburg said. “Advances in recent years in the ways we can intervene to lessen the impact of heart disease and heart attack have really made a difference.”