When a character on a TV show or movie has a heart attack, they clutch their chest or slump to the ground.
February 5, 2025
“In real life, heart attacks can be much more subtle than they look on TV,” said Dr. Patrick Fitzsimmons, a cardiologist at Penn State Health Lancaster Medical Center. Sometimes, heart attack symptoms are so mild that they go unnoticed. This is known as a silent heart attack.
Without fast medical treatment, a silent heart attack can cause irreversible damage. Every second counts as a blocked artery chokes off blood flow to parts of your heart. “That tissue is dying as time goes on, so the time and speed at which people seek medical attention is crucial,” Fitzsimmons said.
What is a silent heart attack?
Of the 805,000 heart attacks that happen in the U.S. each year, about 170,000 are silent. Some silent heart attacks are caused by partial artery blockages, known as mini heart attacks. However, complete blockages can cause silent heart attacks, too. Mild symptoms don’t necessarily mean a mild heart attack.
“People can have severe coronary disease and may not have any symptoms at all,” Fitzsimmons said. “We all have different wiring and warning systems.”
A cardiologist can spot the damage from a silent heart attack on an echocardiogram, an ultrasound test that shows images of your heart. Sometimes an abnormal ultrasound is the first sign a silent heart attack occurred.
What does a heart attack feel like?
Heart attack symptoms can include chest pain or tightness that sometimes radiates down the left arm, jaw pain, nausea, vomiting, shortness of breath or fatigue. Sometimes silent heart attacks cause mild symptoms that people ignore or chalk up to other causes, like orthopedic issues or an upset stomach.
“When people don’t recognize these symptoms as heart symptoms, they tend to come in late for medical care,” Fitzsimmons explained.
Signs of a heart attack in women, older adults and people with diabetes often include shortness of breath, fatigue or a general feeling of illness instead of chest pain, Fitzsimmons said.
Don’t ignore suspicious symptoms that last for 20 minutes or longer. If you think you’re having a heart attack, call 911.
“The biggest mistake people make is sitting at home with ongoing symptoms when it could be their heart,” Fitzsimmons said.
What are the risk factors for a heart attack?
Risk factors for heart attacks include:
- Family history of heart disease
- Smoking history
- High cholesterol
- High blood pressure
- Increased age
- Overweight or obesity
- Metabolic syndrome
- Chronic kidney disease
- Physical inactivity
- History of heart attacks
However, sometimes people with very few risk factors still have heart attacks. That’s why it’s vital to take heart attack symptoms seriously, Fitzsimmons said.
How do silent heart attacks affect health?
Silent heart attacks can increase your risk of heart failure, strokes and sudden cardiac death.
If you get medical help for a heart attack early enough, a cardiologist can perform an angioplasty, a procedure to open blocked arteries and restore blood flow. If not, your heart will sustain damage that could cause death or require more complex treatment, like bypass surgery or stent implantation.
“Heart attacks occur when a plaque ruptures inside an artery and causes a thrombus, or clot,” said Fitzsimmons. “Initially that thrombus is mushy, so if your cardiologist smashes it with a balloon or a stent, it’ll break up, and medications like blood thinners can help your body break it down. The problem is, as the clot organizes and becomes harder, it becomes like a rubber ball that your cardiologist can’t move.”
How can I reduce my risk of a heart attack?
- Move more. Walking for 50 minutes five times per week can reduce your heart attack risk, said Fitzsimmons. If 50 minutes sounds daunting, start with five. Keep moving and improving each day.
- Try a Mediterranean Diet. This anti-inflammatory eating plan rich in fruits, vegetables, olive oil and lean meats can protect your heart. You don’t have to overhaul your entire diet, Fitzsimmons said. Buy a Mediterranean Diet cookbook and try the recipes three times a week. That’s enough to make a difference.
- Get your cholesterol checked. High cholesterol can clog your arteries, increasing your risk of a heart attack. The recommended total cholesterol level is 200 milligrams per deciliter. Ask your doctor if you’re due for a lipid screening.
- Get screened for diabetes. A normal A1c level is below 5.7%. If it’s between 5.7% and 6.4%, it indicates prediabetes. Over time, untreated high blood sugar can damage the lining of your blood vessels and raise your heart attack risk.
- Tell your doctor if something feels off. “People often have symptoms a couple of weeks before they have a heart attack but don’t recognize them because they’re not chest pain,” Fitzsimmons said. “It might happen with activity, shoveling snow or walking up a flight of stairs.” If you have symptoms with exertion, see your primary care doctor for evaluation.
Find out your risk for heart disease. Take Penn State Health’s quick, online heart health assessment.
Related content:
The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.
If you’re having trouble accessing this content, or would like it in another format, please email Penn State Health Marketing & Communications.