THE SILENT HEART ATTACK: SYMPTOMS, DIAGNOSIS, AND TREATMENT
When people hear the term "heart attack", they often imagine a person clutching their chest in pain and struggling to breathe. But heart attack symptoms are not always this dramatic.
The truth is, you can have a heart attack and not even know it – that is known as a silent heart attack.
Like a regular heart attack, a silent one can cause heart damage, heart failure, and death. So why is it called “silent”? Because it does not cause intense pain and other common heart attack signs and symptoms. Most people don’t realize they have had one until weeks or months later when their doctor notices heart damage.
In this article, you will find answers to these questions: What does a silent heart attack feel like? What happens during a silent heart attack? What are the symptoms of a silent heart attack? And how do you diagnose and treat a silent heart attack?
A silent heart attack – sometimes called a “painless” heart attack – happens without the telltale symptoms of a heart attack, such as chest pain, stabbing pain in the arm, shortness of breath, and nausea.
Like any heart attack, a silent heart attack occurs due to inadequate blood flow to part of the heart muscle, which can strain and damage the heart. And the longer the blood flow is blocked, the greater the damage.
Usually, the pain and discomfort people experience during a heart attack drives them to seek immediate medical attention. That helps restore the blood flow to the heart promptly and minimize possible damage.
But a silent heart attack may go unnoticed or be mistaken for a less harmful condition (like indigestion) because it does not cause those symptoms that most people are familiar with. Because a person may not realize they are having one, a silent heart attack could go without treatment for a long time, which can cause significant heart damage, heart failure, and possibly death.
Studies vary, but many found that silent heart attacks are more prevalent in men than women. Studies also suggest that people with diabetes are at higher risk of a painless heart attack than non-diabetics.
If it does not cause symptoms, how do you know if you are having a silent heart attack?
Well, in many cases, a silent heart attack does cause symptoms, but they are not as severe or intense as those of a classic heart attack. So they are not as easily recognizable.
Most heart attacks cause sharp pain, tightness, pressure, or squeezing in the chest (typically on the left side) that could last a few minutes or go away and return over several hours.
With a silent heart attack, you may only feel slight discomfort or soreness in the middle of your chest instead. That discomfort might feel like indigestion, heartburn, or gastric reflux, which are much less dangerous conditions, so most people ignore them.
A classic heart attack can cause stabbing pain in the arm, jaw, neck, or upper back.
If you are having a silent heart attack, you may feel moderate discomfort in your upper body (jaw, neck, arm, or upper back). It could feel like there is pressure on your back or like you have a sore upper back muscle.
Although these are warning signs of a silent heart attack, many people brush it off as regular body aches.
A silent heart attack can present with other symptoms, including:
- Shortness of breath while doing tasks that do not require much effort – this could happen with or without chest pain.
- Fatigue and physical discomfort (people usually chalk off these silent heart attack symptoms as being overworked or not getting enough sleep).
- Dizziness, lightheadedness, and faintness.
If you are struggling with tasks that were not difficult before – like walking up the stairs, going out for a stroll, or taking your pet out for a walk – make sure to tell your healthcare provider about it because it might be a sign of a silent heart attack.
Sometimes, silent heart attack symptoms feel like the flu: You get nauseated, vomit, or break out in a cold sweat.
When you feel like there is something wrong with your body, do not ignore it. Take it up with your healthcare provider to rule out a more severe condition than the common cold.
Because the symptoms are subtle, many people do not realize they have had a silent heart attack. If you experience any warning signs, seek medical attention immediately, even if you are unsure whether you are having a heart attack.
Silent heart attacks show up on electrocardiograms (ECG or EKG) and echocardiograms. If you think you have had one, your doctor will review your symptoms, medical history, and family history. If they suspect a heart attack, they will order an EKG to confirm the diagnosis.
There is no way to predict a silent heart attack before it happens. However, some risk factors can increase your chances of having one (or any heart attack), such as:
- Age (the older you get, the higher the risk of a heart attack)
- High blood pressure
- High cholesterol
- Inactivity (not getting enough exercise)
- Family history of heart attacks or cardiac disease
If you suspect a heart attack (silent or not), the first thing you should do is call an ambulance or have someone drive you to the nearest hospital.
Taking Aspirin while waiting for emergency care could relieve symptoms and reduce possible heart damage. Do not take Aspirin if you are allergic to it or your doctor has warned you against it.
If you have been prescribed nitroglycerin, take it as recommended by your doctor while waiting for medical help.
At the hospital, silent heart attack treatment will include the following:
- Your healthcare providers will monitor your heart
- You will be given oxygen to help you breathe better
- You will be given medicine to open up blocked blood vessels and prevent blood clots
Your doctor may need to perform a procedure (called an angioplasty or balloon angioplasty) to open up the blocked blood artery. Some patients might need a stent inside the blood vessel that keeps it open so blood can flow and reach the heart more easily.
Your doctor will prescribe meds to continue taking after you return home. These medications might include:
- Calcium channel blockers
- ACE inhibitors
A silent heart attack increases your risk of having another heart attack, which can cause heart failure and even death.
Because silent heart attacks are often diagnosed late and sometimes even missed completely, the best you can do is make these lifestyle changes to reduce your risk of having one:
- Stop smoking
- Lower your cholesterol (if you have high cholesterol)
- Control your blood pressure (in those with hypertension)
- Regulate your blood sugar (if you have diabetes)
- Get close to your ideal weight
- Exercise regularly
- Take all your meds as prescribed by your doctor
A silent heart attack can be managed and treated effectively; many people can live long and healthy lives after a heart attack. But remember, “An ounce of prevention is worth a pound of cure.”
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- Silent Myocardial Ischemia - StatPearls - NCBI Bookshelf
- Silent Myocardial Infarction and Long-Term Risk of Heart Failure in the Atherosclerosis Risk in Communities (ARIC) Study - PMC
- Recognizing “painless” heart attacks - PMC
- Coronary artery disease: Signs of a heart attack - InformedHealth.org - NCBI Bookshelf
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