When we think of heart attacks, a common image comes to mind: a person clutching his or her chest, doubled over in pain. But it’s quite possible to have a heart attack without chest pain. In fact, it’s possible to have no symptoms at all. The lack of symptoms doesn’t mean these events are insignificant, though. They can cause lasting damage that goes untreated and increases the risk for a second—and potentially fatal—cardiovascular event.

How can it be silent?

Often, people learn they experienced a silent heart attack only when imaging shows evidence of previous heart damage. While some people recall no symptoms at all, others look back and recognize that they felt something—just not a classic heart attack symptom. They may have felt indigestion, a pulled chest muscle, or flu symptoms. They may have had sweating, lightheadedness, nausea, or shortness of breath. Or they may have had very mild classic symptoms—chest pain and pressure, or pain in the arm, neck, or jaw—that didn’t feel severe enough to cause alarm.

Gender differences in silent heart attacks

Women more commonly experience these kinds of nontraditional symptoms, possibly because they are more likely to have blockages in the smaller arteries that supply blood to the heart, in addition to the main arteries. But while the symptoms of a silent heart attack may be different, the underlying process is the same: Blood flow to the heart is blocked, potentially damaging the heart muscle.

Risk factors

The risk factors for a silent heart attack are no different from a traditional one:

  • Advanced age. Men ages 45 or older and women ages 55 or older are more likely to have a heart attack.
  • Excess weight. Being even somewhat overweight is a risk factor, and the risk rises along with body mass index.
  • High blood pressure. The excess strain from high blood pressure causes the coronary arteries to stiffen and narrow.
  • High cholesterol. Strive to keep your total cholesterol under 200 milligrams per deciliter (mg/dL) and your low-density lipoprotein (LDL) cholesterol under 100 mg/dL. If you have coronary artery disease, aim for less than 70 mg/dL.
  • Lack of exercise. You need 150 minutes per week of moderate- intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both.
  • Tobacco use
  • Family history of heart disease. This is a significant risk factor, but it does not increase the likelihood of symptoms being vague or silent.
  • People with diabetes may have a higher likelihood of silent events, particularly if they also have neuropathy.

Future risk

A person who has experienced a silent heart attack has an elevated risk of having another attack. Because they didn’t know they had an event, they had no medical intervention to limit damage to the heart. Further, there are no clues to guide ongoing monitoring. If you are concerned that you may have had a silent heart attack, talk to your doctor about your symptoms to see if you should undergo testing.

Whether that testing reveals a prior heart attack or not, you can immediately begin to lower your risk of a first or subsequent event by following a heart-healthy diet, reducing stress, exercising, losing weight, and managing other conditions like diabetes and high blood pressure.

If you are concerned that you may have had a silent heart attack, talk to your doctor. A medical professional can review your symptoms and health history, and a physical exam can help determine if you need more tests.

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