Skip to main content

Editor's pick: Originally published June 15.

The terrifying conclusion in a recent study published by the American Heart Association is that almost half of all heart attacks go undiagnosed. That is right: the person has a heart attack and doesn't know it, In most cases, life just goes on.

Sort of. In many cases a silent heart attack - as they are called by physicians - causes significant damage to heart muscle that will lead to a lower quality of life. Said Christopher Carrubba, a physician: "This can lead to cardiac dysfunction that may present later as declining exercise capacity, shortness of breath with exercise or at rest, orthopnea (shortness of breath when lying flat), and/or swelling of the lower extremities."

But how can a person just not notice that he is having a heart attack? The usual reason a heart attack goes unnoticed: "The patient does not have the classical chest pain," said Tiffany Sizemore-Ruiz, a board certified cardiologist in Florida.

That's key: most of us have heard, repeatedly, that symptom one of a heart attack is a stifling pain in the chest, a feeling that the chest is squeezed in a vise. Except, said Sizemore-Ruiz, there are multiple types of heart attacks and in one type, yes, chest pain is the norm but in at least one other type, chest pain is anomalous.

Marco Coppola, chief medical officer at in Dallas, added that women in particular often do not have substantial chest pain in association with a heart attack. "They will come into the ER and tell me they feel tired," said Coppola who elaborated that savvy emergency room physicians know to be on the alert for a heart attack even when the patient complains of reflux, tiredness maybe even vague muscle pains.

But other physicians may not be so tuned into what doctors call myocardial infarctions (MIs) - heart attacks to you and me - that come with atypical symptoms.

Understand this too: the overwhelming majority of patients who show up in his emergency room complaining of a possible heart attack have not had one, said Coppola.

Scroll to Continue

TheStreet Recommends

That's the frightening paradox. Many fear they have had a heart attack but most haven't. But 45% of heart attacks are silent MIs, according to that new research led by physician Elsayed Z. Soliman at Wake Forest Baptist Medical Center in North Carolina.

Big as that silent MI number is, it is down from where it had been, said Sizemore-Ruiz, who said, "We are doing a much better job of educating patients."

Physicians, too, increasingly are on the hunt for silent MIs, said Coppola, and a lot of that is associated with knowing which patients are more likely to be a silent heart attack victim. An otherwise healthy male under 40 who has no complaint of chest pains probably is not a heart attack candidate. An obese female over 50 who is diabetic is a prime candidate, no matter what she thinks has brought her to see a doctor.

In that latter case - and in all cases where there is a good possibility of a heart attack - physicians strongly recommend an EKG (electrocardiogram), a comparatively inexpensive test that shows the heart electrical activity. It is believed to be a good indicator of a heart attack.

Another test is to check blood for cardiac enzymes, which are released into the system by dying heart tissue, usually caused by a heart attack.

Smart patients - even ones without chest pains - would do well to request those tests if there are other reasons to suspect a heart attack may be the underlying cause of fatigue or indigestion or whatever has brought the patient to a doctor.

Note, too, that even though it is bad news to delay treatment after a heart attack - in many cases further damage can be stopped and much past damage addressed some time after the heart attack, said Sizemore-Ruiz who added that a lot of the prognosis hinges on how severe the heart attack was and where exactly it occurred in the heart.

As for you right now, you don't know what you are having - but maybe it's a silent heart attack? "Don't waste time looking up symptoms on the web, call 911," said Nieca Goldberg, a cardiologist with NYU Langone Medical Center in New York. "Chewing an aspirin at home when you are having symptoms isn't enough to stop a heart attack." 

This article is commentary by an independent contributor. At the time of publication, the author held TK positions in the stocks mentioned.