Heart attacks without chest pain: How to recognize these 'silent' killers

Teresa Tanoos's picture
Silent heart attack without chest pain
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About 1.2 million Americans have heart attacks each year. It's the leading killer of both men and women, with about one-third of these victims dying before they ever get to the hospital. That's because you can actually have a heart attack and never realize it.

It's called a "silent" heart attack, and it happens more often than you might think, especially in women. Indeed, a new study recently found that one in five women aged 55 and younger do not experience any chest pain at all when having a heart attack.

The study, led by the Research Institute of the McGill University Health Centre (RI-MUHC) and published in JAMA Internal Medicine, is the first-of-its kind to describe these “no chest pain” heart attacks, including the implications for emergency room care providers treating at-risk individuals when seconds count and can mean the difference between life and death.

Heart attacks, also referred to as acute coronary syndrome (ACS), are important to quickly and correctly diagnose, particularly when there is no chest pain.

“We need to move away from the image of an older man clutching his chest, when we think about acute coronary syndrome,” says senior author of the study, Dr. Louise Pilote, director of the Division of General Internal Medicine at the MUHC and McGill University and professor of medicine at McGill University.

“The reality is that chest pain, age and gender are no longer the definers of a heart attack. Our study demonstrates that young people and women who come into the emergency without chest pain, but other telltale ACS symptoms such as weakness, shortness of breath and/or rapid heartbeats are in crisis. We need to be able to recognize this and adapt to new standard assessments in previously unrecognized groups such as young women,” explained Dr. Pilote.

Heart Attack Symptoms in Women May Not Include Chest Pain

“Women less than 55 years old are more likely to have their ACS misdiagnosed in the ER than men, and they have higher risk of death,” adds first author Dr. Nadia Khan, associate professor of Medicine, UBC. “The public and physicians need to be aware of this problem.”

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The research team also notes that chest pain is not always an indicator of disease severity. In other words, ACS without pain can be just as severe and debilitating as a heart attack with chest pain.

For the study, Drs. Pilote and Khan, along with their colleagues examined more than 1000 patients under age 55 who were hospitalized for ACS. Their findings revealed that, compared with men, women were less likely to experience chest pain – and that such absence of pain did not correlate with less severe heart attacks.

Put simply, patients without chest pain experienced fewer symptoms overall, but their ACS was not any less severe. Therefore, the diagnosis of ACS was dependent on the patient receiving detailed cardiology assessments.

Accordingly, it’s crucial for people to recognize the symptoms of a heart attack and know that chest pain may or may not be one of them.

“It is important to remember that chest pain is a main indicator of ACS, but not the only one,” says Dr. Pilote.

Some of the other indicators or symptoms for these "silent" heart attacks include clammy skin, dizziness, a burning sensation in the chest and unexplained fatigued.

“We need to remind ourselves that even without chest pain, something serious could still be happening,” adds Dr. Khan.

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SOURCE: JAMA Internal Medicine, Sex Differences in Acute Coronary Syndrome Symptom Presentation in Young Patients, Khan NA, Daskalopoulou SS, Karp I, et al (published September 16, 2013)

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