Feature Archive

Silent Symptoms

Becoming aware of unrecognized heart attacks.

WebMD Feature

Feb. 21, 2000 (San Francisco) -- You'd certainly know if you were having a heart attack, wouldn't you? After all, you couldn't possibly miss symptoms as unmistakable as crushing chest pain or extreme shortness of breath.

Or could you? As it turns out, more than one in five people over the age of 65 who have heart attacks have "unrecognized" ones, according to a study published in the January 2000 issue of the Journal of the American College of Cardiology. Researchers evaluated nearly 6,000 men and women aged 65 and above. Of the 901 subjects in whom an electrocardiogram -- a test to record the electrical current that runs through the heart muscle -- indicated a prior heart attack, more than one fifth had had heart attacks that had gone undetected until the test was done. Most patients had no clear indications of cardiovascular disease when they started the study. These so-called "silent" heart attacks are of two types, says P. K. Shah, M.D., Director of Cardiology at Cedars-Sinai Medical Center, Los Angeles. "One kind is truly silent -- it has no symptoms. The other has symptoms, but they are either very mild or are ignored because they are usually not associated with heart attacks, such as sweating or indigestion."

Because these silent heart attacks go undetected, they can't be treated. This increases the chances of underlying heart disease becoming more advanced and causing another, more serious heart attack. But with simple awareness, you can do much to reduce the risk of overlooking such a "silent" attack.

Taken by Surprise

Fourteen years ago, Joseph Smith (not his real name), an 80-year-old Californian, suffered an episode of vertigo that caused him to go to the emergency room. An electrocardiogram revealed that he had at some point in the past suffered a silent heart attack that his doctor described as "significant."

"Looking back, I couldn't think of any signs or symptoms that I'd missed, and I was disturbed to learn that I'd had a heart attack and not known it," Smith says.

Then, eight years later, Smith experienced mild chest pains but waited three months before seeing a doctor. When he finally went for medical help, a stress test and an angiogram revealed blocked coronary arteries, and he underwent quintuple bypass surgery. Today, he's relatively healthy, considering his history.

What's Known, What's Not

Smith's case isn't unusual. Though exact numbers aren't known, many younger people also experience unrecognized heart attacks. "Unfortunately, there's no way to predict who's likely to have them," says Stuart Sheifer, M.D., a fellow in cardiology at Georgetown University Medical Center in Washington, D.C., and the lead author of the study published in the cardiology journal.

In terms of heart damage, these unrecognized attacks aren't necessarily less severe than classic ones. "The first and only symptom of a silent heart attack could be sudden death," Sheifer says. After six years of follow-up in the study, his team of researchers found that death rates from silent heart attacks were the same as those from non-silent heart attacks.

Vigilance Pays

To reduce the chance of a heart attack passing unnoticed, you can become more aware of some unexpected symptoms that accompany such an event. "Most 'silent' heart attacks really aren't silent; they're just not noticed," says Richard Stein, M.D., Chief of Cardiology at the Brooklyn Hospital Center in New York. "If questioned carefully, many patients will recall some vague symptoms, such as indigestion or back pain, that they blamed on something else at the time."

Be extra-vigilant of symptoms if you have heart-disease risk factors, such as a family history of heart attack or other heart disease, obesity, inactivity, smoking, diabetes, high blood pressure, or high cholesterol.

If you have risk factors, you should also talk to your doctor about getting frequent electrocardiograms, Sheifer says. If an old heart attack is detected, it is wise to undergo a thorough treadmill test or other kind of screening.

The Voice of Experience

Smith says his experiences have made him more health conscious. "I learned how to exercise and watch my diet, and not to delay seeking medical help if I had any symptoms at all."

As Stein says, "If you have any doubts, go to the emergency room. Don't worry about embarrassment -- it's better to be embarrassed than dead."

Sharon Cohen is a senior editor at Shape and Fit Pregnancy magazines.

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