Silent heart attacks: Much more common than we thought in both men and women

Deepak Bhatt, MD, MPH

On television, heart attacks are portrayed in rather dramatic fashion — typically, an older man clutching his chest with agonizing pain. This mental image is embedded in our culture, but it actually represents only a small fraction of heart attacks. As it turns out, a variety of different symptoms may develop with a heart attack. In addition to chest pain, some of the other symptoms that can occur with a heart attack include chest pressure, chest heaviness, arm pain, neck pain, jaw pain, shortness of breath, sweating, extreme fatigue, dizziness, and nausea. That is, in part, why it is not always so easy to diagnose a heart attack. And of course, women are also at risk for heart attacks. Whether women are more likely than men to have these symptoms other than chest pain remains a controversial point.

Now, research from the Atherosclerosis Risk in Communities (ARIC) Study has found that almost half (45%) of heart attacks appear to be clinically silent — that is, not associated with any symptoms at all, at least that the patient can recall. These sorts of silent heart attacks were picked up by use of a routine electrocardiogram (ECG). And these silent heart attacks weren’t just a meaningless abnormality picked up on a test. The silent heart attacks were associated with a similar risk of subsequent death as clinically detected heart attacks.

Older studies had more or less come up with similar findings. The present study extended these observations into a much more diverse population. The excess risk associated with silent heart attacks was found to be present in both men and women. Of note, rates of both types of heart attack were higher in men than in women. There was also an excess risk of future death associated with both clinical heart attacks and silent heart attacks in both white and African American patients. Other races were not examined in this study, and more work needs to be done in this regard, though likely the results would be similar.

What does this mean for people who are worried about heart attacks? Guidelines for physicians from professional medical societies in general no longer recommend routine ECGs in healthy people, though this used to be a common practice. Certainly, if you should have an ECG for some purpose, such as before certain types of surgery, and a silent heart attack is detected, that needs to be taken seriously — really, as though you had had a clinically apparent heart attack. Any medications and lifestyle changes prescribed as a result of detecting a silent heart attack should also be relatively similar.

Future studies will have to determine if certain populations might benefit from routine screening for silent heart attacks. Beyond any studies done within the world of conventional medical research, the increasing availability of various apps will allow people to get ECGs on themselves, so detection of silent heart attacks will probably increase. The risk of this sort of indiscriminate screening is that one test abnormality might lead to another set of more expensive and risky tests. So, hopefully we can sort our relatively quickly (i.e., in the next few years) who might be best served with routine screening with ECGs, or perhaps even more sophisticated tests to detect silent heart attacks or people at risk for them.

Related Information: Harvard Heart Letter

Comments:

  1. Florence

    My aunt just died Saturday and ever since then I being feeling a little pressure in my right side I think it’s just because I’m taking her death so hard and she died from a heart attack I think

  2. Rosie

    I am still not clear why there are no symptoms in silent heart attacks. Who coined the phrase “silent” heart attack? Why/how does this happen?

  3. Janie Woodin

    My insurance company refuses to pay for a screening EKG with a well women visit. I am 69 years old. The insurance company states the new Obama guidelines prohibit routine EKG with annual well women examine. If I have no symptoms should I have a EKG? ?

  4. Ifeanyichukwu olchukwu Joe

    I have pains on my chest and I have gone to see so many doctors and I was told that nothing is wrong with me. Pls am I really ok? Or do I need another check up?

    • Venkat Warren. M.D.

      JOE! I presume you have had the basic cardiac screening tests in addition to a very good cardiovascular examination by a Cardiologist. These include the Treadmill stress test with and without echocardiogram and if needed the Thallium Adeno MIBI nuclear test and the screening for Diabetes, Hyperlipidemia and Hypertension. I also presume you do not abuse tobacco products and your BMI is not over 30 ! Given all these assumptions, all you need to do is follow your doctors advice and get periodic health check ups! Good luck ! For your information, I am a Cardiologist ! Cheers. V. Warren.

  5. Nellie Masters

    I have heaviness in my chest and sharp pain in my upper back, with nausea and clammy skin and I feel tired.

    • Jennie Damerell

      Hi Nellie,

      I’m not a physician, but I strongly encourage you to get those symptoms checked out today if possible, or at the least, contact your physician today to fill them in on exactly what your symptoms were.

      Those symptoms you had could be potentially a heart related problem, or some other potentially serious problem.

      I’m an R.N. with over 20 years of experience. My current specialty is Advice and Triage(ruling out emergencies and urgent conditions).

      I hope all is well with you, but please do not ignore what happened. Sometimes life doesn’t give us a new lease when we wait and see what happens, instead of getting it checked out.

      Jennie

  6. Richard Joseph peter Byrne

    This one’s for you Peggy Sue, you broke my heart.