Features July 2018 Issue

Silent Heart Attack: Like a Time Bomb

Unusual or nonexistent symptoms make it no less dangerous.

Most people know the classic symptoms of heart attack: pain in the left or center of the chest often described as heaviness, tightness or pressure, which can radiate to the jaw or left arm and may be accompanied by shortness of breath, sweating and nausea.

But one-quarter of heart-attack sufferers experience different symptoms or no symptoms. Some learn they’ve had a heart attack (myocardial infarction, or MI) when a test performed for another reason reveals the damage. Others find out when they develop symptoms of heart failure, such as shortness of breath or leg swelling, or an arrhythmia (palpitations or fainting).

But make no mistake: A silent MI can be as dangerous as a full-symptom MI, and sometimes more so.

“People who suffer the classic symptoms of MI usually seek medical care. With a silent MI, the person may not recognize it as such and miss an opportunity to get treatment that may prevent complications down the road,” says Cleveland Clinic cardiologist Chadi Ayoub, MD.

Symptoms Can Be Subtle

heat attack

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Silent MIs are more common in men than women. However, women are more likely to have atypical symptoms, while men are more likely to have no symptoms at all.

Atypical symptoms can be subtle and easily mistaken for less serious problems.

“A heartburn-like sensation is common,” says Dr. Ayoub.

Some people have pain in the arm or neck that feels like a pulled muscle or a lung problem. Others experience shortness of breath, extreme fatigue or a vague feeling that something is not quite right.

“You expect these feelings to pass—and, often, they do. Nevertheless, the MI causes permanent damage,” says Dr. Ayoub.

Are You a Candidate?

The risk factors for a silent MI are the same as for any MI. However, diabetes is common among silent MI sufferers and is associated with atypical symptoms, such as a sharp or burning pain, arm or jaw pain alone or simply shortness of breath.

“People with diabetes may have high blood sugar levels that damage nerve endings and alter the sensation of pain,” Dr. Ayoub explains.

Prior open-heart surgery may also change the perception of pain, increasing the risk an MI may be silent.

Yet these don’t explain all silent MIs. “We are trying to learn more about why some people don’t experience chest pain,” says Dr. Ayoub.

Why You Should Speak Up

The best way to avoid damage from a silent MI is to call your doctor’s office if your gut tells you something isn’t right or you are experiencing an unusual, unexpected symptom.

“If it turns out to be reflux, it can be addressed,” says Dr. Ayoub. “But if it turns out you have suffered a silent MI, you will need the same treatment as someone who has suffered a regular MI. This will include daily aspirin, a statin, perhaps other medications, and tests to open up any blockage in an artery.”

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