In some cases, heart attacks are just as dramatic as you expect them to be. But just as the signs of heart failure can be chalked up to other, less serious, causes, the symptoms of a “silent heart attack” can seem like a fluke occurrence. In fact, the signs may be so subtle that you have no idea you had a heart attack at all.
During a silent heart attack, damage occurs to the heart without causing the classic heart attack symptoms that would prompt a trip to the emergency room, explained Robert Greenfield, M.D., a cardiologist. “Often, we only find out [that] happened after they’ve had a second heart attack and that first, silent one shows up in their test results.” These attacks can even happen in your sleep, he added. You may be jarred awake—but chalk it up to a bad dream or snoring and then go back to sleep.
Meet the experts: Robert Greenfield, M.D., a cardiologist; Olujimi Ajijola, M.D., Ph.D., a cardiologist and electrophysiologist at UCLA Health; Adriana Quinones-Camacho, M.D., a cardiologist at NYU Langone Health.
Still, the same risk factors apply for silent heart attacks as for those that present more classically, explained Olujimi Ajijola, M.D., Ph.D., a cardiologist and electrophysiologist at UCLA Health. High blood pressure, high cholesterol, diabetes, smoking, substance use, stress, and family history can all make them more likely.
Dr. Ajijola noted that diabetes patients may be at an especially high risk for silent heart attacks. “Chronic diabetes causes degeneration of the heart’s autonomic nerves, which typically alert one to a heart attack,” he explained. “Also, women may have a higher risk of not recognizing the signs of a problem because they tend to have atypical symptoms for heart attacks, like abdominal pain, jaw discomfort, or just feeling generally unwell.”
Does that mean you can never tell when a silent heart attack is happening? Not necessarily. While silent heart attack symptoms may not be obvious, there are some subtle signs experts say you can learn to recognize.
Silent heart attack symptoms
Shortness of breath
The heart and lungs work together to make sure your blood gets enough oxygen. And when something goes wrong in your cardiovascular system, your breathing is usually affected immediately, said Adriana Quinones-Camacho, M.D., a cardiologist at NYU Langone Health. You might feel winded just walking across a room—or even feel short of breath when you’re sitting still.
Some people mistake sudden shortness of breath or quickened breathing for a panic attack. However, deep breathing exercises are one of the best strategies for how to stop a panic attack—and these won’t help if you’re having a silent heart attack. So if you feel like you can’t “reset” your system with deep breathing, or if you feel like you simply can’t get enough air, you should probably see a doctor.
Racing heart rate
When there’s a problem, your heart will immediately try to course-correct. That often means pumping faster, said Dr. Ajijola, so your heart could race until it reaches a dangerous heart rate. You might also notice a change in the way the upper chambers of your heart are beating, causing an irregular heartbeat (arrhythmia). This can feel like your heart is skipping beats or banging against the wall of your chest.
Sudden weakness or fatigue
As your heart struggles to remedy whatever is happening, it will divert resources away from what it considers nonessential functions. That can make the muscles in your arms and legs feel weak or heavy. According to Dr. Greenfield, many people find it difficult to stand or walk when this happens, because they feel such an intense wave of fatigue.
Nausea or indigestion
Another area of the body the heart considers non-vital in a crisis is your digestive system. As your body pulls resources from that area, there will be less oxygen in your bloodstream, and that can cause sudden nausea, indigestion, and abdominal cramps. Dr. Greenfield said it’s possible to mistake this for heartburn, because it can cause tightness and burning in your chest.
Body or muscle aches
According to the University of Utah, a silent heart attack can cause body-wide symptoms that seem unrelated to your cardiovascular system. These include muscle soreness in your chest, upper back or arms, an ache in your jaw, or feeling like you have the flu.
Feeling off
This is the most challenging silent heart attack symptom to spot, said Dr. Quinones-Camacho. After all, don’t we all feel lousy sometimes? Feeling stressed, tired, and a bit out of breath—for many people, that’s not a silent heart attack, it’s just another Monday morning. But when that feeling is accompanied by a racing heart or overwhelming fatigue, it could be more than the usual blahs.
How to reduce your risk of a silent heart attack
People who survive a heart attack, silent or otherwise, are at higher risk for another attack because of potential heart damage, Dr. Quinones-Camacho said. However, there’s quite a bit you can do to prevent another.
“Lifestyle changes make a huge difference, even if you have significant family history,” she said. “If [having heart attacks] runs in your family, talk to your doctor, because it may make sense to start medications like statins. Also, find out your blood pressure and cholesterol numbers.”
From there, consider heart-healthy habits, like filling your plate with the best foods for heart health, getting regular exercise, reducing stress, getting enough sleep, and making time for social connections.
“The best part about following tips for better heart health is that it has a ripple effect,” said Dr. Greenfield. “All these strategies to keep your heart strong can lead to having more energy, sleeping better, getting fit, and generally just enjoying your life more.”
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