How to Spot a Silent Heart Attack

May 22nd 2016

Aron Macarow

We've been taught to associate heart attacks with chest pain, shortness of breath, and other acute symptoms. But a new study in the journal Circulation suggested that nearly half of all heart attacks may lack these traditional symptoms — or any symptoms at all. Dubbed "silent heart attacks," they can be just as deadly — and possibly even more so for women, researchers said.

A standard heart attack commonly features symptoms such as chest pain or discomfort, shortness of breath, cold sweat, nausea, light-headedness, and pain or discomfort in both arms. A silent heart attack can be much harder to identify: Subtle signs can include unexplained fatigue and discomfort in the jaw, arms, or upper back. But the results are the same.

"The outcome of a silent heart attack is as bad as a heart attack that is recognized while it is happening," said study author Elsayed Z. Soliman, director of the epidemiological cardiology research center at Wake Forest Baptist Medical Center in Winston-Salem, N.C. "And because patients don't know they have had a silent heart attack, they may not receive the treatment they need to prevent another one."

Individuals who suffer from a silent heart attack frequently don't receive appropriate medical treatment, and their chance of dying from heart disease increases threefold afterward. Worse, a silent heart attack victim's chances of dying from all other causes increases by more than one-third.

So how can you spot a silent heart attack?


A silent heart attack has very few noticeable symptoms, as described by the Mayo Clinic.

"Just like the name implies, a silent heart attack is a heart attack that has either no symptoms or minimal symptoms or unrecognized symptoms," said Deborah Ekery, a clinical cardiologist at Heart Hospital of Austin and Austin Heart in Austin, Texas.

Some people mistake the mild symptoms of a silent heart attack for "indigestion or a case of the flu," sometimes even thinking that they "strained a muscle in their chest or their upper back," Ekery said.

Silent heart attacks are often detected only by electrocardiogram, a process that monitors the heart's electrical activity. That may occur weeks or months after the heart attack has happened.

Why are they more deadly for women?

Silent heart attacks make up 45 percent of all heart attacks, according to researchers, and are more commonly found in men. But women are the most likely ones to die.

That's because women are more likely to minimize their symptoms or have their symptoms mistaken for other medical conditions, New York University cardiologist Nieca Goldberg said.

The treatment for a silent heart attack is the same as for a more traditional one: reduce weight, quit smoking, control cholesterol, lower blood pressure, and get more exercise. The most important factor is identifying the problem — which means knowing the signs.

"If we miss a silent heart attack, we miss the opportunity to prevent the second heart attack," Goldberg said.

Editor's note: This piece has been updated to have better attribution.