When people think of a heart attack, they often imagine pounding chest pain and difficulty breathing — classic signs of reduced blood flow to the heart. But up to 20% of heart attacks are "silent," meaning their symptoms are mild, vague or go unnoticed.
"Most likely, these individuals had signs of heart disease, but the symptoms weren't significant enough to prompt them to seek medical care," explains Sachin Parikh, M.D., a cardiologist at Henry Ford Health.
Heart Attack Risk Factors
Many factors influence your risk of developing heart disease and having a heart attack, silent or otherwise. The more risk factors you have, the greater your overall risk.
Some of these factors are beyond your control. Others are modifiable and can be improved with lifestyle changes or medical treatment. There are also contributors that can add pressure on the heart without directly causing disease. Here's how they break down:
Factors You Can't Change
- Increasing age: The risk of a heart attack increases as you get older.
- Sex: Men are more likely to have noticeable heart attacks, while women are more likely to experience silent ones.
- Genetics and family history: A family history of heart disease increases risk of heart attack. Certain racial and ethnic groups — including African Americans, Mexican Americans, American Indians, Native Hawaiians and individuals fom South Asia — face a higher burden of heart disease.
Factors You Can Change
- Smoking: Cigarette smoking is known to increase your heart rate and heart disease risk.
- High cholesterol: Elevated LDL cholesterol levels contribute to plaque buildup in arteries, which can reduce blood flow to the heart.
- High blood pressure: Persistent high blood pressure strains and thickens the heart muscle over time, impairing optimal function. It can also directly affect the function of your arteries.
- Excess body weight: Being overweight or obese — especially with extra weight around the waist — raises heart disease risk, even without other risk factors.
- Diabetes: Diabetes accelerates atherosclerosis and can mask symptoms due to nerve changes. Many people with diabetes experience silent or atypical heart attack symptoms.
- Physical inactivity: Regular, moderate-intensity exercise helps keep other risk factors in check including cholesterol, blood pressure, blood sugar and weight. If you're not physically active, you're missing out on that protection.
Additional Heart Disease Contributors
- Chronic stress
- Heavy alcohol use
- Unhealthy diet and poor nutrition
Silent Heart Attacks Explained
Those individuals most vulnerable to silent heart attacks fall into one of three categories: women, people with diabetes and older adults.
"These groups are at higher risk because they may not experience the classic symptom of chest discomfort that we associate with a heart attack," Dr. Parikh notes.
Instead, symptoms may be subtle and easily dismissed:
- Mild chest pressure or discomfort
- Jaw or tooth pain
- Indigestion or nausea
- Unexplained fatigue
- A tightness or achiness that comes and goes
- Shortness of breath
These signs may also come on with activity and seem to improve with rest.
Heart Attack Prevention Basics
Early evaluation is key to prevention. If you have multiple risk factors, consider seeing a heart specialist when you're in your 40s. Every adult should undergo regular cardiovascular risk assessments —typically beginning in early adulthood and by age 50.
"You may have suffered a silent heart attack without ever recognizing the symptoms," says Dr. Parikh. "It is important to be honesty about any new symptom, even if subtle."
To assess your heart health, your doctor may recommend blood tests (including a cholesterol panel), an electrocardiogram, stress testing, an echocardiogram or alternate imaging.
"One of the most common reasons people avoid a heart evaluation is fear," Dr. Parikh says. "But confronting risk early — with healthy habits and medication when necessary — can significantly reduce your chances of stroke, heart attack or life-threatening events."
Reviewed by Dr. Sachin Parikh, a cardiologist who sees patients at Henry Ford Hospital and Henry Ford Medical Center - Plymouth.
