Silent Heart Attacks: Causes, Symptoms, Treatment

Written by Reshma Pathare on Sun, 11 December 2022 — Fact checked by Dr. Sintayehu Abebe

Key Highlights

  • Silent heart attacks comprise almost 45% of total heart attacks.
  • Silent heart attacks are more common in women than men.
  • Diabetics having type 2 diabetes are more prone to silent heart attacks.
  • There are no particular diagnostic tests to see if you’re prone to a silent heart attack. They can only be ascertained via ECGs or MRIs after they happen, so as to prevent another, more serious episode.

A silent heart attack, technically known as a silent myocardial infarction (SMI) or silent ischemia, is literally a heart attack that comes without any overt warnings or signs.

It can come without any symptoms, or with extremely minimal symptoms, or with unrecognized symptoms.

Understanding silent heart attacks

Many a times, a person suffers from a silent heart attack and doesn’t even know it, till they visit a doctor to get examined for continual fatigue or acidity or some such typical symptoms of a heart attack. At such times, the clinical examination may reveal damage to the heart that may have happened weeks or months back, which may be attributable to a silent heart attack.

  • A silent heart attack happens when the supply of oxygen-rich blood to the heart is cut off or reduced because of plaque build-up in the arteries, or a blood clot blocking the arteries.
  • Sometimes it may happen due to a sudden spasm in the coronary artery that can block the oxygenated blood flow.
  • A silent heart attack may come (and go) while you’re sleeping.
  • It may strike if you undergo a sudden and large-scale physical or emotional trauma.
  • It may also come if your level of physical activity suddenly increases by several levels, especially in colder climate.

Types of silent heart attack

Silent heart attacks are broadly segregated into three types, depending on the types of patients who suffer from them.

Type 1: Occurs in completely asymptomatic patients having no history of angina or myocardial infarction. This is a rare form of silent heart attack and the victim may already be having a CAD but displays no symptoms of the same.

Type 2: Occurs in people who have previously had myocardial infarction, but are now asymptomatic

Type 3: Occurs in people showing some anginal symptoms (such as chronic stable angina, unstable angina, and vasospastic angina) and having asymptomatic ischemic events. This is the commonest form of silent heart attacks amongst the three.

Types of people at risk for silent heart attack

As far as gender comparison goes, women are more prone to silent heart attacks than men, because typically, women display less overt symptoms of heart ailments as compared to men.

Women with impending heart problems show symptoms like acid reflux, fatigue, and indigestion–all subtle symptoms that keep showing up before a silent heart attack in both genders.

However, men with heart problems tend to get more overt symptoms like severe chest pain, thus making their ailment easier to diagnose in time.

Diabetics with type 2 diabetes are at high risk for getting a silent heart attack, which is attributable to cardiac autonomic dysfunction in such people.

People suffering from sleep apnea (which mostly happens due to obesity or being overweight) can cause several heart problems – a prominent one among them being silent heart attacks.

Critically ill patients who are mostly admitted in the ICU are at risk for a silent heart attack even if they’re not suffering from any cardiac problem per se.

Post-operative cardiac patients too are at risk of silent heart attack even after a successful surgery and recovery. This is especially true of old-aged patients, and those who have undergone a bypass surgery.

Why are diabetics more susceptible to silent heart attacks

People having diabetes–especially, type 2 diabetes–are more susceptible to getting silent heart attacks.

Diabetes is a lifestyle disorder that brings along several complications, prime among them being wildly fluctuating blood sugar levels.

When the blood sugar levels fluctuate erratically as they do in diabetes, over a period of time it causes damage to the blood vessels, thus increasing the person’s susceptibility to heart problems.

When the blood vessels are damaged, it alters the circulation system of the body, and that leads to a condition called ‘neuropathy’ aka nerve damage.

Neuropathy is known to create tingling, pain, and also loss of sensation in feet and toes. But additionally, it also leads to extended nerve damage elsewhere in the body. This phenomenon is called autonomic neuropathy, which when it affects the heart can lead to silent heart attacks in diabetics.

Since the autonomic nervous system controls essential physical functions like breathing and heart rate, a damage to the heart is highly probable among diabetics.

Also, since neuropathy causes loss of sensation, it becomes more difficult to ascertain when a silent heart attack comes and goes.

Symptoms of a silent heart attack

As the name indicates, symptoms of a silent heart attack are very inconspicuous or minimally severe. In fact, it because of the covert nature of the symptoms that a silent heart attack becomes difficult to detect before it strikes. While a regular heart attack may be characterized by anginal pains, shortness of breath, sudden twinges of pain the arm or back etc., silent heart attacks will be preceded by less-obvious symptoms like repeated indigestion, getting light flu (running a bit of temperature), feeling sore in the back or chest, feeling some pain the jaw or arms, feeling tired, or having acid reflux.

Some people may feel some pressure or fullness on the chest, but it may not be severe enough or prolonged enough to feel like preceding a heart attack.

Another symptom of a silent heart attack is feeling dizzy after climbing stairs or having trouble breathing properly after walking even a bit fast than usual.

If you feel nauseous more often than normal, or get vomiting spells, then too it may be a sign of an impending silent heart attack.

Diagnosing silent heart attacks

There are no particular tests to diagnose a silent heart attack well in time, or to ascertain whether you’re prone to having one imminently.

In such a scenario, prevention becomes better than cure.

The best way to avoid being struck by a silent heart attack is to be aware of which risk factors are you particularly affected by. For instance, if you’re a menopausal woman and are suffering more acid reflux episodes than usual, it is better to visit a doctor for timely diagnosis. Similarly, if you’re a smoker, or have a family history of heart problems, it is prudent to go for at least one check-up in a year.

Such check-ups can help a doctor ascertain your vulnerability to the problem, and suggest preventive measures before it goes out of hand.

In case you’ve already had a silent heart attack without knowing, tests like an echocardiogram or electrocardiogram, heart MRI, or an ultrasound can help in proving that you did undergo a silent heart attack, the level of damage it has caused, and what measures should you now undertake to prevent a bigger episode.

Treatment and aftercare

Since silent heart attacks are mostly diagnosed only after they affect a person, treatment is aimed at preventing another or a more complex episode in the future.

Hence, depending on the severity of the damage caused by the attack, as well as the risk factors you face, the doctor will either suggest lifestyle changes such as quitting smoking or eating a healthy diet; or, will suggest medicines like aspirin, statins, beta blockers and ACE inhibitors.

Since there’s a 35% chance of having a heart failure follow a silent heart attack, maintaining a healthy, stress-free lifestyle and taking the prescribed medicines properly is the best aftercare for people affected by the ailment.


All heart problems are serious in their own ways, but a silent heart attack is more so because even though it may not cause great damage immediately, the fact that it goes unnoticed most of the times is a cause for worry in the long run.

That is because, it may cause quite a lot of damage before diagnosis and subsequent happens.

Hence, it is advisable to go for an annual health check-up to measure one’s vulnerability to heart attack in general.

On an individual level too, keep cognizance of your risk factors, weigh them against the symptoms you might be seeing (even if they seem innocuous), and take medical advice without much ado.

A little awareness and a proactive attitude go a long way in preventing oneself from falling prey to silent heart attacks.


Reshma Pathare

Reshma Kulkarni-Pathare has been a self-employed media professional since 1999. Starting off as a Freelance Journalist for Times of India Thane Plus, Reshma went onto write for more than 45 national and international publications including Times of India, New Woman, Femina, Indian Express, The Hindu, BBC Good Homes and many more. While her forte has been lifestyle writing, she is equally proficient in writing health articles. Her health articles have been published in Health International (Dubai), New Woman, Femina, and Mother & Baby.

Apart from being a journalist, Reshma also works as a copy-editor for self-publishing houses and academic journals.

She is an award-winning bi-lingual translator with more than 12 books published in her name.

She has been a Visiting Faculty Member for post-graduate department of mass media at MET College (Mumbai) and Welingkar WeSchool (Mumbai).

She has worked as a Consumer Marketing Insights Researcher for global organizations like CEB Iconoculture (USA) and Gartner (USA).

Consolidating her multifarious skills in the media, in 2021, Reshma launched her own boutique media agency called Talking Turkey Communications, which specializes in content writing, editing, and translation.

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