by Julian Tan

ABOUT 25% of ‘normal’ heart attacks are silent and don’t show the usual symptoms of chest pain and breathlessness. Who’s more likely to experience a silent heart attack, how can we identify one when it occurs and what can we do to prevent one from happening in the first place? We ask Dr Julian Tan, an interventional cardiologist practising at Mount Elizabeth Hospital, Singapore, your questions about silent heart attacks.  

If the symptoms of a silent heart attack are so subtle, how can we tell that we are having one before it’s too late?
The classical signs of a heart attack are central, crushing chest pain with breathlessness. However, there are more subtle signs of a heart attack: profuse sweating, stomach “ache”, tooth or jaw ache, left arm “numbness”, sense of impending doom/anxiety attack.

Are some people more prone to getting silent heart attacks than others?
People with diabetes are notoriously known to have heart attacks without the classical chest pain symptoms. This is because diabetic patients have more serious heart blockages, which are more extensive (diffuse), more hardened vessels (calcified). Also, diabetics have impaired nerve endings, so they may not feel the pain of a heart attack, hence the term, silent heart attack.

What happens if we overlook a silent heart attack and not seek help?
Heart attacks essentially damage the heart muscles (they die off or get infarcted). So if left untreated, irreversible damage to heart muscles can occur, resulting in heart failure.

I’ve never heard of silent heart attacks. How rare are these and should I be worried?
Silent heart attacks are not rare at all. Roughly a quarter of heart attacks are “silent”.

What can I do to stave off silent heart attacks? Do I have to do anything in particular as compared to preventing normal heart attacks?
It is no different than from preventing conventional heart attacks. Quit smoking, exercise, stick to a healthy and balanced diet, and manage risk factors like hypertension, high cholesterol, diabetes.

What sort of treatment can I get for silent heart attacks?
You can get the same treatment for silent heart attacks as for conventional heart attacks.

How long do I have to recognise the signs and seek help before the silent heart attack becomes fatal?
It’s unpredictable. Heart attacks can be fatal very quickly or result in chronic heart failure symptoms over many years.


Dr Julian Tan is a cardiologist practising at Mount Elizabeth Hospital and Parkway East Hospital, Singapore. He specialises in interventional cardiology, which involves treating diseased heart vessels or coronary artery disease.

The “Ask a doctor” series is run in partnership with Mount Elizabeth Hospitals.


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