A Heart-to-Heart About Heart Attacks

The “silent” heart attack — why don’t we hear about it more often?

Turns out that nearly half of all heart attacks may be silent, meaning that those heart attacks have no traditional symptoms. The problem with these heart attacks is that the person may not receive the treatment to prevent further damage — or another attack.

Silent heart attacks are more common in men but more likely to cause death in women.

A new study in Circulation from Wake Forest Baptist Medical Center details this phenomenon. It occurs when the body has a heart attack without classic symptoms, such as pain in the chest, shortness of breath, or cold sweats.

“Just like the name implies, a silent heart attack is a heart attack that has either no symptoms or minimal symptoms or unrecognized symptoms,” Dr. Deborah Ekery, a clinical cardiologist at Heart Hospital of Austin in Austin, Texas, said on the American Heart Association’s Go Red for Women website. “But it is like any other heart attack, where blood flow to a section of the heart is temporarily blocked and can cause scarring and damage to the heart muscle.”

“People who have these so-called silent heart attacks are more likely to have non-specific and subtle symptoms, such as indigestion or a case of the flu, or they may think that they strained a muscle in their chest or their upper back.”

It also may not be discomfort in the chest. “It may be in the jaw or the upper back or arms,” she said. “Some folks have prolonged and excessive fatigue that is unexplained. Those are some of the less specific symptoms for a heart attack, but ones that people may ignore or attribute to something else.”

45 Percent of Heart Attacks — Silent
Researchers evaluated records from 9,498 middle-age adults and noted that 317 participants had silent heart attacks, while 386 had heart attacks with clinical symptoms over a nine-year average. They followed up on them for more than two decades to better understand long-term complications. They took into account other factors such as smoking, diabetes, body weight, cholesterol levels, and blood pressure. They did not adjust for access to care but did adjust for income and education, which could impact access to care.

In total, silent heart attacks made up 45 percent of all heart attacks. People who had them had were three times more likely to die of heart disease. Silent heart attacks increased the chances of dying from all causes by 34 percent. They were more common in men but more likely to cause death in women. Researchers also say that African-Americans may fare worse than whites.

Know Your Risks
People with hypertension or diabetes should make sure to treat those conditions — they are more likely to have a silent heart attack. That’s according to Dr. Michael Miller, a Baltimore-based cardiologist and author of “Heal Your Heart.”

“New symptoms such as increased fatigue, or shortness of breath when climbing a flight of stairs or during exertional activities not previously present in the past should be evaluated,” Miller said.

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Dr. Dennis A. Goodman, a professor of cardiology who specializes in preventative medicine and lipidology at the New York University’s Langone Medical Center in New York City, noted that silent heart attacks are no less dangerous than traditional heart attacks.

“In many ways, they can be more dangerous,” Goodman said.

Though silent heart attacks cannot be prevented, people can reduce their risk factors. People with high blood pressure, diabetes, obesity, family history, high stress levels, or smoking habits should talk to their doctor about cutting their risks for heart attacks — silent or not.

Anyone who has experienced atypical symptoms should go to the doctor to confirm if it’s a silent heart attack — an EKG and blood tests can detect if a heart attack has occurred. A calcium scan can identify if there is plaque, which is when Goodman begins to treat patients for subclinical coronary artery disease.

“For half the people who die of a heart attack, it’s their first and last symptom,” Goodman said. “It can cost you your life.”

Think you’re experiencing symptoms? Stay calm and call 911. When you get to the hospital, make it clear you think you may be having a heart attack and not an anxiety attack.