Can You Have a Heart Attack and Not Know It? Silent Heart Attack Signs

February 20, 2023

This article was reviewed by our Baystate Health team to ensure medical accuracy.

Kelly M. Wanamaker, MD Kelly M. Wanamaker, MD View Profile
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Are you tired? Do you have indigestion? Thinking you may have pulled a muscle in your upper back, chest or arms? Don’t ignore these subtle symptoms. You could be having a silent heart attack.

According to the American Heart Association (AHA) silent heart attacks account for around 170,000 of the estimated 805,000 annual heart attacks. All too common, silent heart attacks are often overlooked.


“Silent heart attack or myocardial ischemia is a condition of reduced oxygen-rich blood flow to the heart without symptoms of chest discomfort or other equivalent symptoms such as difficulty breathing, nausea, sweating,” said Dr. Kelly M. Wanamaker, cardiac surgeon, Baystate Health and assistant professor, Cardiothoracic Surgery, UMass Chan Medical School-Baystate. “This is accompanied by changes on studies such as an electrocardiogram (EKG) that looks for electrical changes or echocardiogram (echo), an ultrasound of the heart that looks at function.”

Dr. Wanamaker also shared that it’s imperative to know and understand the risk factors. The risk factors for a silent heart attack are the same as those for a heart attack with symptoms. Risk factors include diabetes, age, excess weight, family history, high blood pressure, high cholesterol, lack of exercise, obstructive sleep apnea, tobacco use and prior heart attack.


While a silent heart attack doesn’t have the same common signs or symptoms as a heart attack, there are still subtle signs to watch out for. According to the American Heart Association, some silent heart attacks may present as:

  • No symptoms
  • Minimal symptoms
  • Indigestion
  • Flu-like symptoms
  • Strained muscles in neck, chest, or upper back
  • Discomfort in the chest, jaw, upper back, or arms
  • Prolonged or excessive fatigue

If you have symptoms of a silent heart attack, don’t dismiss them. Go to the emergency department or call 911.


“It has been reported that patients with silent heart attacks have a greater chance of developing new coronary events than those without silent ischemia, therefore, they need an aggressive diagnostic and therapeutic approach. The risk for those with silent heart attacks includes an increase in complications or death since patients often do not seek medical attention in a timely fashion,” said Dr. Wanamaker.

Many people don’t realize they’re having a silent heart attack because they’re not having obvious symptoms. However, Dr. Wanamaker shared some can be medically managed with beta blockers, which help to decrease the heart’s demand by lowering the heart rate and blood pressure, aspirin to make the platelets less sticky and allow blood to flow freely, and lipid-lowering therapies. 

February is American Heart Month – a time to shine a spotlight on heart disease, the number one killer of Americans. Take time this month to focus on your cardiovascular health and understand your risk factors for heart disease.

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