What is a Silent Heart Attack?

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A silent heart attack, also called a silent Ischemia, is a heart attack that has either no symptoms, minimal symptoms or unrecognized symptoms. A heart attack is not always as obvious as pain in your chest, shortness of breath and cold sweats.

Can you have a heart attack and not know it?

Yes. A heart attack can actually happen without a person knowing it. You can understand why it is called a "silent" heart attack.

Hard to Recognize Symptoms of a Silent Heart Attack

“Just like the name implies, a silent heart attack is a heart attack that has either:

  • no symptoms,
  • minimal symptoms or
  • unrecognized symptoms,” says Deborah Ekery, M.D., a clinical cardiologist at Heart Hospital of Austin and with Austin Heart in Austin, TX.

“But it is like any other heart attack where blood flow to a section of the heart is temporarily blocked and can cause scarring and damage to the heart muscle.”

Ekery regularly sees patients who come in complaining of fatigue and problems related to heart disease, and discovers, through an MRI or EKG, that the person had actually suffered a heart attack weeks or months ago, without ever realizing it.

“People who have these so-called silent heart attacks are more likely to have non-specific and subtle symptoms, such as:

  • indigestion or
  • a case of the flu, or
  • they may think that they strained a muscle in their chest or their upper back.
  • It also may not be discomfort in the chest, it may be in the jaw or the upper back or arms,” she says.

“Some folks have prolonged and excessive fatigue that is unexplained. Those are some of the less specific symptoms for a heart attack, but ones that people may ignore or attribute to something else.”

Causes of a Silent Heart Attack in Women

A silent heart attack happens when the flow of blood is blocked in the coronary arteries by a build up of plaque. Studies differ, but some suggest that silent heart attacks are more common in women than in men.

Ekery points out that women and their physicians may also be more likely to chalk up symptoms of a silent heart attack to anxiety and dismiss them.

Risk Factors for a Silent Heart Attack in Women

Still, Ekery says, the risk factors for a silent heart attack are the same as those for a recognized heart attack, and:

A silent heart attack can be just as dangerous as its more obvious counterpart, says Ekery. Because the event often leaves scarring and damage to the heart, it puts the person at greater risk of other heart problems. And because the person didn’t know to seek treatment, blood flow to the heart might not have been restored early on, and no medications were administered, so the impact could potentially be greater.

What to do during a silent heart attack.

The “silent” in a silent heart attack is the complicating factor—often, women don’t realize they’re experiencing a medical emergency. If you do notice symptoms of a silent heart attack, try to stay calm and call 911 immediately. When you get to the hospital, make it clear that you think you may be having a heart attack and not an anxiety attack. Advocate for yourself or, if you can, bring along someone who will advocate for you.

How to prevent a silent heart attack.

Ekery advises her patients to:

  • know their risk factors,
  • be aware of their blood pressure and cholesterol,
  • exercise regularly and
  • avoid smoking to decrease their risk of a heart attack.
  • Above all, she cautions them to listen to their bodies, and if something isn’t right, talk to a doctor.

“People know their own bodies, and if something seems unusual, they ought to be evaluated,” she says, “particularly if they have any of those risks.”

Written by American Heart Association editorial staff and reviewed by science and medicine advisors.

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Last Reviewed: Sep 7, 2020