A silent heart attack, in the absence of known symptoms or occurrence of mild discomfort, often gets passed over in diagnosis. But the scarring of the heart muscle is real, which means a complication shows up sooner rather than later. And it is during that time when patients realise that they have had a cardiac event weeks, may be months, before. But once it is attended to and future risks are mitigated, people who have had a silent heart attack could have the same long-term survival as those who have had an ordinary heart once. This was borne out by a study in 2018. However, people who have had a silent heart attack may be at risk of other complications, such as heart failure and stroke.
According to another 2018 study, a person who has had a silent heart attack, has an estimated 35 per cent higher risk of heart failure than a person without a history of heart attacks. People in their early 50s or younger have an even greater risk increase. “A silent heart attack is more frequent in overweight, hypertensive, diabetic people, those who have had prior heart attacks and smokers,” says Prof (Dr) Rajesh Vijayvergiya, Department of Cardiology, Advanced Cardiac Center, PGIMER, Chandigarh.
What is a silent heart attack?
A heart attack is a medical emergency that occurs when the blood supply to the heart muscle is totally lost due to complete occlusion or blockage of the coronary artery. Most heart attacks are associated with symptoms of sudden onset of severe pain at the centre or left side of the chest, excess sweating, uneasiness, restlessness, nausea, vomitting or shortness of breath. If the symptoms remain continuous and persist for more than half an hour, urgent medical attention is required. It is possible that certain individuals may have minimal or no symptoms of chest pain. But they may have a discomfort in the neck and back which is ignored/unnoticed or guessed as heartburn, indigestion and muscle pain. This type of presentation, when a heart attack is missed by an individual, is considered a silent heart attack.
Are silent heart attacks seen more in men or women?
Silent heart attacks are more frequent in people who are overweight, hypertensive, diabetic, smokers and those who have had prior heart attacks. It’s a misnomer that such heart attacks only affect the elderly population above 50-60 years of age. A younger healthy individual – a man or woman of less than 50 years of age – can have a silent heart attack. Symptoms of a heart attack in them are often ignored or misdiagnosed leading to serious complications. Women are more likely to have a silent heart attack due to sheer negligence or misinterpretation of chest pain.
How common are silent heart attacks?
Silent heart attacks are very frequent. The incidence varies depending on geographical area, social status, availability of health services and so on
How do silent heart attacks affect our bodies?
Heart attacks, whether silent or with marked chest pain, are an emergency, requiring immediate medical treatment. Delayed treatment can result in permanent damage or scarring of heart muscles, which may manifest later as heart failure, arrhythmias and sudden cardiac death. A missed heart attack at the first time does invite a second heart attack later in life because of a lack of treatment and a simultaneous lifestyle correction.
What are the symptoms of a silent heart attack, as compared to a traditional one?
Pain on the right side of the chest, at the jaw, neck or back of the chest, fatigue, cold sweat, nausea and lightheadedness are a few atypical symptoms. Given the high-risk profile of Indians, any discomfort and uneasiness of this nature lasting beyond 15 to 20 minutes, should be reported to a neighbourhood hospital. Do not ignore sharp neck pains. An electrocardiogram (ECG) and echocardiogram can make a diagnosis of a silent heart attack.
How can silent heart attacks be prevented?
Prevention of a heart attack requires the adoption of a healthy lifestyle. This begins with a diet makeover — There must be an adequate intake of vegetables, fruits, cereals and fibre, decreased salt intake and an avoidance of deep-fried fast foods, packed snacks, processed food, bakery products and alcohol. A regular 30-45 minute moderate to vigorous exercise every day, at least five days a week, is a must. Management of risk factors for heart attacks such as hypertension, diabetes, obesity, physical inactivity and smoking plays an important role in prevention.
What are the treatment options?
As there is a delayed presentation in a silent heart attack – and the best revival prospects are within a golden period of one to two hours – the physician needs to assess the damage already caused by a coronary blockage by a battery of tests. There are certain medicines which must be taken for each and every heart attack patient for years. Good drug compliance and regular medical follow-ups are a must to avoid a future heart attack and to avoid the complication of a missed silent heart attack.
If doctors diagnose a previous silent heart attack, they may recommend that a person take medications like aspirin, statins, beta blockers and blood pressure lowering medicines like ACE inhibitors or angiotensin receptor blockers to help lower the risk of a future heart attack.
What are the precautions one must take after a heart attack?
Follow a healthy lifestyle, control your body weight, and take appropriate treatment for blood pressure, diabetes and cholesterol. Maintain good drug compliance and regular medical follow-ups with the treating physician. Recognise the potential symptoms of a heart attack and take medical assistance as an emergency to avoid complications. Silent heart attacks can be as dangerous as traditional heart attacks, and it’s essential to take due precautions after experiencing one.
Why Dr Vijayvergiya?
Dr Rajesh Vijayvergiya is professor in the Department of Cardiology, Advanced Cardiac Centre, PGIMER, Chandigarh. He is credited as one of the pioneers of the latest interventional cardiology practices in North India. He has performed more than 22,000 procedures, which include coronary and peripheral intervention, interventions for structural heart disease and cardiac arrhythmias. He has a specific interest in complex coronary bifurcation and left main intervention, intravascular imaging and functional assessment of coronary lesions. He has written for more than 200 publications in PubMed indexed journals, 15 chapters in reputed medical books, and more than 100 abstract presentations in various national and international scientific meetings.
Silent heart attacks are more frequent in people who are overweight, hypertensive, diabetic, smokers and those who have had prior heart attacks. (Photo: Getty Images/Thinkstock) 
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