Dear Doctor: My wife just had her yearly checkup, and when her blood test results came back, she was told that she had recently suffered a heart attack. How can that be, since she never had any symptoms?
Dear Reader: Your wife had what is known as a “silent” heart attack. Just as the name suggests, it’s a heart attack that occurs without the person realizing it happened. In many cases, though, it turns out the episode wasn’t all that silent after all. It’s true that the person didn’t experience the numb left arm or sudden chest pain that we all recognize from movies and television, often referred to as the “Hollywood” heart attack. However, upon review, many people will realize they were aware of different, subtler symptoms that signaled a heart attack was taking place.
A heart attack occurs when something causes the flow of blood to the heart to become blocked. Without the oxygen and nutrients supplied by a network of blood vessels known as the coronary arteries, the heart muscle begins to die. This causes an array of symptoms. The most commonly known symptoms of heart attack include pain and pressure in the chest, and pain or discomfort in one or both arms. Additional symptoms include pain or discomfort in the neck, jaw, back or stomach; nausea; light-headedness; dizziness; shortness of breath; sudden sweating; and fatigue. These can be so mild, brief or even innocuous that the person never connects them to a heart attack.
Studies suggest that silent heart attacks are more common in women than in men. Women are also more likely to experience symptoms that are unrelated to chest pain. People who have had a silent heart attack may later recall feeling dizzy or short of breath, having a bout of stomach pain or nausea, or experiencing a neck ache or unusual fatigue. These symptoms are easy to attribute to other causes, such as a case of the flu, stress, indigestion or a strained muscle. However, as in your wife’s case, blood tests will reveal elevated levels of a protein known as troponin T or troponin I. These are released into the blood when the heart muscle is damaged.
The risk factors for any type of heart attack are the same. These include a prior heart attack, a family history of heart disease, using tobacco products, high blood pressure, high blood cholesterol, being overweight, poor diet and lack of exercise. Age and race also play a role.
After someone has had a heart attack, they can make lifestyle changes to lower risk. These include quitting smoking; reaching and maintaining a healthy weight; adopting a healthful diet; managing chronic health conditions, such as diabetes; and becoming physically active. If appropriate, medications to control high blood pressure and high blood cholesterol will be prescribed.
If anyone has the symptoms of a silent heart attack, it’s important not to ignore them. Early treatment will not only lessen the amount of damage that is done to the heart, it may well save your life.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.