Heart attacks without chest pain: Why atypical symptoms are dangerous

Causes of silent heart attack: Obstructive sleep apnea (OSA) can cause all sorts of problems like heart attack (silent or symptomatic), cardiac arrhythmias, pulmonary hypertension, heart failure, transient ischemic attack, and stroke (Image: Pexels)

A heart attack, you always thought, is accompanied with acute agonizing pain in the chest and extreme shortness of breath. These are classic symptoms of heart attack. But did you know that every heart attack need not show these symptoms?

Such heart attacks, which show no typical symptoms, are called “silent” heart attacks, which can occur without significant chest pain. Instead, such episodes are equally dangerous, because they are mistaken for other ailments, and treatment is delayed.

One example of this phenomenon is called Silent Myocardial Ischemia, where the heart gets less oxygen-rich blood. There is no pain or other symptoms, but indicative investigative tools like ECG or echocardiogram can be markedly abnormal.

Also read | Silent heart attack: Watch out for hidden signs and symptoms that often go unnoticed

The rise in these so-called sudden cardiac events is a growing public health crisis. It highlights the urgent need to raise awareness, as well as improve screening and treatment — particularly in at-risk populations — to avert complications and death before it is too late, says Dr Sunil Wadhwa, Associate Director, Cardiology, Max Hospital, Gurugram.

5 factors to keep in mind

Heart attacks can happen when you are asleep or awake.

• The presence of silent ischemia is a strong mortality predictor. About 70 percent to 80 percent of episodes lack symptoms (silent ischemia).
• Lack of pain in silent myocardial ischemia increases morbidity and mortality since patients do not seek timely medical treatment
• Women and elderly patients, those with diabetes mellitus (DM) or prior heart attacks or revascularization episodes are more prone.

Also read | Heart attacks in young adults: Healthy lifestyle changes and preventive steps

According to Dr Wadhwa, 15-30 percent of patients with acute myocardial infarction have evidence of prior silent myocardial ischemia, and 30-40 percent of those with unstable angina had prior myocardial infarction. Around 20-50 percent of patients with stable angina have a previous history of myocardial infarction.

Silent heart attack

Symptoms of FLU

• Soreness in muscles in chest or upper back
• An ache in jaw, arms or upper back
• Indigestion
• Shortness of breath
• Dizziness
• Discomfort in upper body
• Lightheadedness
• Cold sweats
• Nausea and vomiting
• Tiredness that can last for a few days with no explanation

Also read | How to protect your heart: Atherosclerosis, the silent threat to your heart and blood vessels

Causes of silent heart attack

The basic cause of a silent heart attack remains the lipid rich plaque rupture in the coronary arteries and clot formation. However, other risk factors can include:

• Being overweight (a BMI or body mass index of 25 or more)
• Sedentary life and not getting regular physical activity
• Having DM (high blood sugar), high blood pressure, high cholesterol
• Eating a lot of processed foods that have cholesterol, salt and unhealthy fats in them.
• Stressful lifestyle: Chronic stress, anxiety, and depression
• Using tobacco products: Smoking, vaping
• Preeclampsia during pregnancy
• Infections: Including UTI, pneumonia
• Coronary vasospasm, coronary vasculitis, trauma, coronary embolism, drugs like cocaine,
• Severe anaemia
• Obstructive sleep apnea (OSA) can cause all sorts of problems like heart attack (silent or symptomatic), cardiac arrhythmias, pulmonary hypertension, heart failure, transient ischemic attack, and stroke.

Patients with silent myocardial ischemia may have one of the following clinical presentations:

• Type I: Asymptomatic without prior myocardial infarction. Silent myocardial ischemia is detected on ambulatory monitoring or stress testing.
• Type II: Asymptomatic with a prior history of symptomatic myocardial ischemia
• Type III: Patients with known symptomatic or asymptomatic CAD, the largest group

Diagnostic tests like electrocardiograms (ECGs), stress tests, and blood tests can help diagnose silent heart attacks. If you have risk factors for heart disease or experience any of the symptoms, it is important to consult a doctor for further evaluation.

Disclaimer: This article, including health and fitness advice, only provides generic information. Don’t treat it as a substitute for qualified medical opinion. Always consult a specialist for specific health diagnosis.