Silent Heart Attack

What is a silent heart attack?

A silent heart attack is one that has no symptoms, mild symptoms or symptoms people don’t connect to a heart attack. But it’s still a heart attack (myocardial infarction), which means your heart isn’t getting enough blood flow and oxygen. This injures your heart.

Silent heart attacks can injure your heart just like a more obvious heart attack can. But if you don’t know you’re having a heart attack, you may not get the medical help you need to limit the damage. This is why it’s important to make time to pay attention to how you’re feeling.

Usually, a blood clot causes a heart attack by keeping blood from flowing through one of your coronary arteries. Less often, a coronary artery spasm or injury to your coronary artery wall can cut off your blood flow.

Heart attacks can happen when you’re asleep or awake. They can happen when:

• You just went through something very physically or emotionally stressful.
• You quickly become more physically active.

How common is a silent heart attack?

Researchers estimate that 22% to 60% of all heart attacks are silent. Silent heart attacks may be more common in people who are assigned female at birth (AFAB) or have diabetes.

What are the symptoms of a silent heart attack?

Unlike chest pain (stable angina) that happens with exertion and stops with rest or medicine, chest pain from a heart attack doesn’t stop when you rest or take medicine. But silent heart attack symptoms are the kind you don’t usually associate with a heart attack. You may have mild symptoms or no symptoms at all. You may not realize you’ve had a heart attack.

Symptoms of a silent heart attack can make you feel like:

• You have the flu.
• You have a sore muscle in your chest or upper back.
• You have an ache in your jaw, arms or upper back.
• You’re very tired.
• You have indigestion.

Symptoms of a traditional heart attack may include:

• Chest pain that lasts more than a few minutes.
• Shortness of breath.
• Dizziness.
• Discomfort in your upper body.
• Lightheadedness.
• Cold sweats.
• Nausea and vomiting.
• Tiredness that can last for a few days with no explanation.

What causes a silent heart attack?

Coronary artery disease typically causes a silent heart attack. Plaque that contains cholesterol collects in your coronary arteries, limiting how much blood can get to your heart muscle. When a blood clot forms on the plaque, it can keep oxygen-rich blood from getting through at all. Without quick treatment to restore blood flow, heart muscle can die.

What are the risk factors for a silent heart attack?

Other health issues can put you at a higher risk for a heart attack. These include:

• Having overweight (a BMI, or body mass index, of 25 or more).
• Not getting regular physical activity.
• Having high blood pressure.
• Having high cholesterol.
• Eating a lot of foods that have cholesterol, salt and unhealthy fats in them.
• Having high blood sugar.
• Feeling stressed.
• Using tobacco products.
• Having preeclampsia during pregnancy.
• Having COVID-19 or another infection.

Some things put you at a higher risk of a heart attack, but you can’t change them. These include:

• Having a history of heart disease in your biological family.
• Being Native American, Mexican American, Black or native Hawaiian.
• Being older than 45 and assigned male at birth (AMAB).
• Being postmenopausal or older than 55 (AFAB).

What are the complications of a silent heart attack?

People who wait too long to get help for a heart attack run the risk of severe damage to their hearts and may not survive if they don’t get help soon enough.

Silent heart attacks can lead to abnormal heart rhythms or heart failure. Also, researchers have found a link between silent heart attacks and ischemic strokes.

How is a silent heart attack diagnosed?

During a physical exam, your healthcare provider may find that you have these signs of a silent heart attack:

• A fast or uneven pulse.
• Unusual sounds in your lungs.

What tests will be done to diagnose a silent heart attack?

You may not realize you’ve had a silent heart attack. This is why healthcare providers often diagnose a silent heart attack weeks or months later by:

• Blood tests.
• Electrocardiogram (ECG/EKG).
• Cardiac catheterization with coronary angiography.
• CT scan (computed tomography scan).
• Magnetic resonance imaging (MRI).
• Exercise stress test.
• Nuclear stress test.
• Echocardiogram (echo).

How is a silent heart attack treated?

Without obvious symptoms, many people don’t realize they’re having a silent heart attack. But a heart attack of any kind is an emergency. You should call 911 or your local emergency number right away even if you don’t know for sure that you’re having a heart attack.

A 911 operator can tell you if you should take an aspirin to prevent blood clots. Paramedics can give you medication while you’re in the ambulance.

At the hospital, a healthcare provider will:

• Monitor your heart.
• Give you oxygen.
• Give you medicine for pain and to break up or prevent blood clots (aspirin or thrombolytics).

Procedures to treat silent heart attack

In addition to medicines, silent heart attack treatment often includes procedures. As soon as possible, your provider may do a coronary angioplasty to open a blood vessel that got too narrow or clogged. They can put a stent inside your blood vessel to keep it open so blood can flow through.

In some cases, you may need surgery for a coronary artery bypass graft (CABG) to create a way for blood to go around the clogged area.

Complications of the treatment

Complications of procedures may include:

• Blood clots.
• Bleeding.
• Infection.
• Abnormal heart rhythm.
• Kidney issues.
• Heart attack.
• Stroke.
• Death.

How long does it take to recover from this treatment?

It can take up to a week to recover from angioplasty. But it may take a couple of months to fully recover after bypass surgery.

How can I lower my risk of a silent heart attack?

Taking aspirin and a statin (cholesterol medication) may prevent a heart attack, but be sure to check with your provider before you start taking them. Other things you can do to help prevent a heart attack include:

• Getting regular physical activity.
• Avoiding tobacco products.
• Drinking fewer beverages that contain alcohol.
• Eating healthy foods, like lots of fruits and vegetables, and avoiding red meat.
• Managing your stress level.
• Staying at a weight that’s healthy for you.

If you have medical issues that can increase your risk of a heart attack, taking care of them can help prevent a heart attack.

These medical problems include:

• High blood pressure.
• High cholesterol.
• Diabetes.
• Chronic kidney disease (CKD).
• Peripheral artery disease (PAD).

It’s possible to have another heart attack once you’ve already had one. This is why it’s important to follow your provider’s instructions. Cardiac rehab, which combines education and physical activity, can be helpful, as well.

What can I expect if I have a silent heart attack?

After you go home from the hospital, you’ll need to keep taking the medicines your provider ordered for you. You may need to take some medicines for the rest of your life.

Types of medications may include:

• Beta-blockers.
• Anticoagulants.
• Antiplatelets.
• Statins and cholesterol medications.
• ACE inhibitors and other types of blood pressure medications.

You may feel tired, sad and anxious after having a heart attack. Some people find it helpful to join a support group where they can talk with others who’ve been through a similar experience.

You may be able to get back to your routine (including walking) a few weeks after a silent heart attack. Everyone’s experience is a bit different based on how much their heart attacks hurt their hearts, but most people can get back to doing regular things little by little and have active lives.

How do I take care of myself?

After a silent heart attack, you may need to make some changes in your life, like:

• Eating foods that are good for your heart.
• Getting physical activity on most days of the week.
• Quitting tobacco use.
• Reaching a weight that’s healthy for you.

You should also follow your provider’s instructions and keep taking the medicines they ordered for you. If a provider put a stent in your artery, you’ll probably need to take antiplatelet medicine for six to 12 months. These medicines help keep the stent open.

When should I see my healthcare provider?

You’ll need regular checkups with your healthcare provider after a silent heart attack. In some cases, your provider may want to do another electrocardiogram and echocardiogram.

When should I go to the ER?

If you think you’re having a heart attack, call 911 or your local emergency number. An ambulance is the best option for fast treatment. Paramedics can start treating you once they arrive and continue while you’re on the way to the emergency room.

What questions should I ask my doctor?

Questions to consider asking your healthcare provider may include:

• How concerned should I be about having another heart attack?
• How successful are the treatments for a heart attack?
• What’s the most important thing I can do to prevent a silent heart attack?

A note from Cleveland Clinic

You may be surprised to learn that you’ve had a silent heart attack. Because it’s possible to have another heart attack, this is the time to learn the subtle signs of a silent heart attack (as well as the obvious signs of a traditional one). Take charge and pay attention to what’s normal for your body and get help when something doesn’t feel right. You can also help yourself by treating medical conditions that can lead to a heart attack.