Heart attacks without chest pain: Why atypical symptoms are dangerous

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.

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

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.

• 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

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.