Silent Heart Attacks: Why They Happen and How to Detect Them

January 7, 2026

Dr J Narendra
MD, DM FACC, FSCAI, FESC, FCSI, FICC Consultant Cardiologist

A heart attack is generally conceived as a severe, crushing pain in the chest, but a more hazardous threat exists: the silent heart attack. Referred to as silent myocardial infarctions, they are defined by the blockage of blood supply to part of the heart, as is the case in a normal heart attack, but with less characteristic or no signs at all. They are also fatal; they are very toxic to the heart muscles, but those who have undergone one are not even aware of this until much later, when the individual undergoes a routine check, as they would not experience any symptoms. To save your heart, it is vital to know the specific heart attack causes and the way they may be recognised.

Why Do Silent Heart Attacks Happen?

Silent heart attacks have some similar underlying reasons as the symptomatic ones, and they differ in appearance. A combination of physiological factors and the presence of already existing health conditions are usually identified as the primary heart attack causes.

• Atherosclerosis: Atherosclerosis is the common cause; it happens when plaque can narrow the coronary arteries, and a plaque can rupture and form a clot that suddenly blocks blood flow (a frequent mechanism of acute MI). With a silent one, the obstruction can develop at a slower rate, or the area in the heart blocked can be smaller, producing less effective pain signals.
• Nerve Damage (Neuropathy): This is a common occurrence, especially in patients with diabetes, which causes pain or numbness in certain parts of the body, including the nerves around the heart. The brain is not actually being sent any alarm signals that it otherwise would not be getting.
• High Pain Threshold: There are those people who have a higher pain threshold and thus will not be receptive to pain that may be considered problematic to others.

The risk factors that lead to an ordinary heart attack also predispose the occurrence of a silent heart attack. These include:

• High blood pressure
• Excessive cholesterol (i.e. increased LDL)
• Smoking
• Obesity
• Chronic stress
• History of heart disease in the family.

What are the Subtle Signs? How to Detect a Silent Heart Attack

A silent heart attack is difficult to detect, as the symptoms are usually ambiguous, readily brushed off or confused with other petty conditions. Observing the unexplained changes in your body constantly is essential, more so when one already has predisposing factors.

Irrelevant or unclear symptoms that have to be considered:

• Unusual Fatigue or Weakness: Feeling abnormally tired or weak without any obvious cause, particularly when it is chronic and when it becomes worse with activity.
• Shortness of Breath: Sensation of breathlessness, even with light exercise, or waking up with a shortness of breath.
• Mild Discomfort Anywhere Above the Waist: Sometimes, the pain is felt as a squeeze, pressing, or aching in the jaw, neck, back, shoulders, or arms as opposed to a sharp pain in the chest. It may also be stomach pain, which is confused with indigestion.
• Sudden Sweating: There are incidences of inexplicable cold sweats.
• Lightheadedness, Dizziness, Nausea or Vomiting: These general symptoms, if they appear without any apparent cause, cannot be overlooked.

Diagnostic Tools (in case an incident is suspected):

• Electrocardiogram (ECG/EKG): It can detect electrical variations within the heart that would represent damage to the heart muscle in the past.
• Blood Tests: Troponin detects recent heart attacks. Troponin is a protein that is released by the heart muscle during a heart attack.
• Imaging: An echocardiogram, CT scan or MRI can recognise regions of the heart muscle which are either damaged or demonstrate poor performance.

How to Avoid Heart Attacks and Prevent Future Episodes?

The best solution is prevention because heart attacks that remain silent are deceptive. The most appropriate solution to the question of how to avoid a heart attack and keep your heart safe is proactive lifestyle changes and maintenance of current health problems.

• Healthy Diet: Have a heart-healthy and balanced diet that is rich in fruits, green vegetables, whole grains, and lean proteins. Restrict processed foods, saturated and trans fats, excess sugar and sodium.
• Regular Exercise: At least 150 minutes of moderate-intensity exercise, or 75 minutes of vigorous-intensity exercise, should be done per week. Such changes in habits in physical activity can greatly help prevent heart attacks.
• Maintain a Healthy Weight: Losing a little weight will decrease your risk of heart disease and other related conditions, such as diabetes and high blood pressure.
• Stress Management: Stress leads to high blood pressure and other risk factors among chronic stressors. Add stress-relieving methods such as yoga, meditation or a walk in the woods. 

What if I Have Risk Factors? Understanding Personal Prevention

Those people who have underlying diseases or have a family history of heart disease. This should observe the following:

• Blood Pressure Control: Check your blood pressure regularly and adhere to instructions given by your doctor on how to control high blood pressure, which may involve the use of medicine.
• Cholesterol Management: In case you are suffering from high cholesterol, consult your health professional to help reduce your LDL (bad) cholesterol levels with the aid of diet, exercise, and possibly using some drugs such as statins.
• Diabetes Management: To avoid nerve damage and safeguard the heart, it is essential to control the level of glucose in the blood. Frequent checks cannot be compromised.
• Frequent Check-ups: You have to attend your annual physicals. Such frequent check-ups play an important role in screening, early detection of risk factors, and personalised preventive measures discussion. Your doctor would be able to evaluate your general risk and advise you on how to prevent a heart attack.

When Might Cardiovascular Surgery Be Considered?

Whereas lifestyle changes and drugs are the first lines of defence, on other occasions, more invasive forms of interventions are necessary, especially when the blockages of the arteries are severe, or the incidences of the past have resulted in such a massive effect. Severe cases are normally covered in cardiovascular surgery.

• Angioplasty and Stenting: This is a less invasive procedure whereby a balloon is inserted into the blocked or narrowed artery, which is normally followed by a stent to keep it open.
• Coronary Artery Bypass Graft (CABG): This is popularly referred to as bypass surgery, and it is a very complex cardiovascular operation used to restore a healthy blood vessel from another body that in vessel in creating new routes to the obstructed coronary arteries, allowing the circulation of blood to the heart.
• Valve Repair/Replacement: In some cases, a heart attack may affect heart valve function, and surgical repair or replacement may be recommended after specialist evaluation.

The processes are also complicated and pose risks of their own, and therefore, effective prevention and early diagnosis of a heart attack are the greatest ways to avoid such surgeries.

Nanjappa: The Best Hospital in Shimoga

Nanjappa Hospital is not a mere multi-speciality hospital that is ranked top in Shimoga; we are your fully committed partner in the wellness of the heart. We are also specially designed to incorporate the latest technological advancements and highly qualified professionals, serving the full range of heart health requirements. This includes addressing both heart disorders through risk assessment and providing life-saving treatment.

We not only treat conditions, but we also encourage people and families to take charge of their future, offering the knowledge and clinical excellence to ensure it is sustained.