Silent Heart Attack: Symptoms, Risks


by Kate Silver

A heart attack does not always have obvious symptoms, such as pain in your chest, shortness of breath and cold sweats. In fact, a heart attack can actually happen without a person knowing it. It is called a silent heart attack, or medically referred to as silent ischemia (lack of oxygen) to the heart muscle.

Symptoms of a silent heart attack

“Just like the name implies, a silent heart attack is a heart attack that has either no symptoms or minimal symptoms or unrecognized symptoms,” says Deborah Ekery, M.D., a clinical cardiologist at Heart Hospital of Austin and with Austin Heart in Austin, TX. “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.”

Ekery regularly sees patients who come in complaining of fatigue and problems related to heart disease, and discovers, through an MRI or EKG, that the person had actually suffered a heart attack weeks or months ago, without ever realizing it.

“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 says. “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.”

Causes of a silent heart attack in women

A silent heart attack happens when the flow of blood is blocked in the coronary arteries by a build up of plaque. Studies differ, but some suggest that silent heart attacks are more common in women than in men. Ekery points out that women and their physicians may also be more likely to chalk up symptoms of a silent heart attack to anxiety and dismiss them. Still, she says, the risk factors for a silent heart attack are the same as those for a recognized heart attack, and include high blood pressure, high cholesterol, smoking, family history of heart disease, obesity and age.

A silent heart attack can be just as dangerous as its more obvious counterpart, says Ekery. Because the event often leaves scarring and damage to the heart, it puts the person at greater risk of other heart problems. And because the person didn’t know to seek treatment, blood flow to the heart might not have been restored early on, and no medications were administered, so the impact could potentially be greater.

What to do during a silent heart attack

The “silent” in a silent heart attack is the complicating factor—often, women don’t realize they’re experiencing a medical emergency. If you do notice symptoms of a silent heart attack, try to stay calm and call 911 immediately. When you get to the hosptial, make it clear that you think you may be having a heart attack and not an anxiety attack. Advocate for yourself or, if you can, bring along someone who will advocate for you.

How to prevent a silent heart attack

Ekery advises her patients to know their risk factors, be aware of their blood pressure and cholesterol, exercise regularly and avoid smoking to decrease their risk of a heart attack. Above all, she cautions them to listen to their bodies, and if something isn’t right, talk to a doctor.

“People know their own bodies, and if something seems unusual, they ought to be evaluated,” she says, “particularly if they have any of those risks.”


  • Deborah schoenfeld

    In your section on atherosclerosis, why do you use a male figure in the illustration of the heart? Are you talking to women? I’m looking at that illustration and trying to figure out where are my breasts, where is my waist? If you were talking to men, would you use a female body?? Who wrote this article? I think it was a man. Also, your first topic of discussion is sex. I do not think a woman’s first concern is when she can have sex again. Come on.
    I find all of these descriptions of women’s heart attack symptoms so lame. “Oh, I have a stomach ache. It must really be a heart attack!”

  • genny zentella

    My aunt had complained of stomach problems, thought she had indigestion so they didn’t call an ambulance right away. They were going to take her to a clinic to get her checked, but she started getting worse so they called an ambulance, but it was too late; and she died of a heart attack. She was 68.

  • Gennica Fajardo Gennica

    I have been experiencing pain in my chest. It started on the right side then after a few days, it went to the left side. Now it’s right in the middle of my chest and it feels like a strained muscle. After reading this, I am going to see a doctor.