Beware the Silent Heart Attack: What to Watch For

Pay heed to subtle or unusual symptoms
man yawning tired working

The vast majority of people who have a heart attack experience traditional symptoms, like chest discomfort or pain, cold sweat and extreme weakness.

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But a subgroup of people — around 20% to 30% — experience atypical symptoms or no symptoms at all. “While atypical heart attack symptoms are most common among women and people with diabetes, they can happen to anyone,” says cardiologist Curtis Rimmerman, MD.

What are these unusual symptoms?

Non-classic symptoms of heart attack may include the following:

  • Unexplained fatigue.
  • Shortness of breath.
  • Discomfort in the throat, neck, jaw or a single extremity.

Some patients may only experience what they believe is heartburn and simply take antacid medication to relieve it — instead of recognizing that the pain could be heart-related.

Dr. Rimmerman notes that most people think heart attacks cause a sharp pain on the left side of the chest. “Yet heart attacks most often cause discomfort in the center of the chest, along with a sensation of unremitting squeezing, fullness or tightness,” he says.

Given the way TV and movies portray heart attacks as obvious events, it’s not surprising that less common heart attack symptoms pass unnoticed.

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How silent heart attacks are discovered

Some patients whose heart attacks go unrecognized learn about them weeks or months later when they visit the doctor, often for a yearly physical.

“We can tell the size of the heart attack by how much heart muscle has been damaged, often on an electrocardiogram (EKG), or even more precisely on a cardiac ultrasound, or echocardiogram,” says Dr. Rimmerman.

Other patients visit their doctors soon after a silent heart attack because they experience persistent symptoms, such as fatigue and shortness of breath.

Sometimes these symptoms are caused by a leaky mitral valve, caused by scarring of the heart muscle and associated valve dysfunction after a heart attack. Serious complications can follow, including decompensated heart failureheart rhythm disorders and loss of consciousness.

Don’t ignore persistent discomfort

“People who experience a heart attack without recognizing it and who survive are very fortunate,” Dr. Rimmerman says. “If you experience sustained discomfort for a period of a few minutes, especially if the symptoms are new and have no clear explanation, do not ignore these concerns.”

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Often, people sense that something is wrong but do not want to believe it is a heart attack, Dr. Rimmerman adds, ignoring symptoms or attributing them to something else.

In one case, for example, a patient thought he had food poisoning only to find out a few days later that he had, in fact, had a heart attack.

If you develop new-onset symptoms resembling heartburn, or any of the symptoms above, be sure to seek care immediately.

“If it turns out to be heartburn, at least you have excluded something less threatening,” says Dr. Rimmerman. “Don’t let uncertainty lead to regret later on for you and your family.”

The bottom line? Don’t be your own physician, he warns: “If you experience a distinct change in how you feel, no matter how subtle, you should seek medical attention.”

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