13.JUN.2017 8 MIN READ | 8 MIN READ

Silent heart attacks are more common than we think, and they can happen without the victim realising it.

Last updated on 3 September 2020

Dr Leslie Tay, an interventional cardiologist at Mount Elizabeth Hospital, talks about heart attacks that happen without obvious symptoms, and the subtle signs you should watch out for.

What is a silent heart attack?

A heart attack is when one of the heart arteries become blocked to the point where blood flow is weakened. The heart muscle becomes deprived of oxygen and nutrients, gets damaged and eventually dies as a result.

During a heart attack, patients normally experience severe crushing chest pain or a heaviness often described as an elephant sitting on your chest. This is usually accompanied by cold sweats and nausea.

A silent heart attack occurs when a patient does not experience these full-blown symptoms. They may feel nothing at all, but more often than not, they have subtle symptoms which might be mistaken for a less critical condition.

What causes a silent heart attack?

The causes of a silent heart attack are the same as that of a normal heart attack. Over years, the heart arteries narrow from deposits of cholesterol and plaque. These deposits can suddenly rupture, bleed and block off the artery, which leads to heart muscle damage.

How common are silent heart attacks?

Silent heart attacks are definitely more common than we think.

Recent studies show that almost half of all heart attacks were silent. People were just unaware of their critical condition. As a result of not seeking treatment, they had a higher risk of dying.

Thus, you must be vigilant if you have any risk factors for heart attack – particularly if you have diabetes. Diabetics are more prone to having a silent heart attack as the poor circulation and high sugar in their blood damages their nerve cells such that they do not experience pain the same way as someone with no diabetes. They could step on a nail and not feel it.

What are the signs and symptoms of a silent heart attack?

If you have any of the following signs and symptoms, it may indicate a more serious condition, such as a silent heart attack:

  • Discomfort in the back, arms, jaw or chest
  • Dizziness or fainting spells
  • Overly exhausted and shortness of breath
  • Heartburn sensation

The signs of a silent heart attack are subtle. Patients may feel a discomfort in the back, arms, jaw or chest. They may experience dizziness or fainting spells. They may feel overly exhausted and breathless after a few steps when a week ago they could run up a flight of stairs. They may have what they think is a heartburn sensation or an upset tummy. These are all subtle symptoms that may be a sign of a heart attack.

I have had a number of patients who have had a silent heart attack. One patient described what he felt as a severe gastric and heartburn sensation lasting over 2 days. This was accompanied by an overwhelming sense of fatigue. By the time he came to hospital, his heart muscle was damaged to a point where heart failure had set in. We had to open up the blocked artery in the hope that the heart muscle may recover.

Basically, the key would be to listen to your body as you know your body best. If you feel that something is not right, you should get it checked out.

What if I don't seek medical help immediately?

A heart attack is a serious condition and can potentially lead to death. If you experience any of the subtle symptoms mentioned above, see your doctor to for an assessment.

How can an interventional cardiologist help?

In general, cardiologists treat patients with heart disease as well as manage risk factors like hypertension, and cholesterol. In the case of a heart attack, an interventional cardiologist performs a procedure to open up the heart arteries to restore blood flow and stop the heart attack.

How can I prevent a silent heart attack?

We recommend these approaches to prevent getting a silent heart attack:

1. Go for health screening to identify any existing artery blockages you may have and get treated if necessary.

2. Identify any risk factors such as diabetes, high blood pressure, high cholesterol, obesity and smoking.

3. Work with your doctor to keep your risk factors under control.

4. If your doctor prescribes medication, take them regularly.

5. Stop smoking. Smoking almost guarantees your heart disease or cancer in your lifetime.

6. Make lifestyle changes like eating healthily and getting regular exercise.

7. Avoid being sedentary, as it gives you almost 3 times the risk of death compared to being overweight but active.

8. Get 20 minutes of exercise a day to significantly reduce your risk of heart attacks.

In conclusion, my message is to go for health screening and identify your risks, keep your risk factors under control, and adopt a healthy lifestyle with healthy eating and exercise. This will minimise your risk for developing a heart attack for years to come.


Article reviewed by Dr Leslie Tay, cardiologist at Mount Elizabeth Hospital


Bhatt D. (2016, June 10) Silent heart attacks: Much more common than we thought in both men and women. Retrieved from https://www.health.harvard.edu/blog/silent-heart-attacks-much-common-thought-men-women-201606109749

Tay Leslie
Mount Elizabeth Hospital

Dr Leslie Tay is a cardiologist practising at Mount Elizabeth Novena Hospital, Singapore.