The ‘Silent’ (Yet Potentially Deadly) Heart Attack: What You Should Know

January 22, 2019

Clinical Contributors to this Story

Jason Sayanlar, M.D. contributes to topics such as Cardiac / Heart Health.

By Brianna McCabe

We all know the signs of a heart attack, right?

After all, it’s constantly depicted in movies in the following sequence of camera shots: the scene opens with the character clutching his or her chest – feeling an electrifying pain radiate to both arms – followed by a dismal groan and an ultimate crash to the floor.

End scene.

“It’s not always like that, though,” explains Jason Sayanlar, M.D., board certified in cardiovascular disease, nuclear cardiology, echocardiography and internal medicine. “In fact, that’s almost always an exaggeration of what most patients describe.”

A typical heart attack occurs when there is a blockage of one of the arteries that supplies blood to the heart and is usually signaled by chest pain, nausea and diaphoresis – an exaggerated form of sweating. “However, tell-tale signs aren’t always present,” adds Dr. Sayanlar. This, the Hackensack Meridian Health Medical Group and Hackensack University Medical Center physician says, is known as a ‘silent’ heart attack.

“In these cases, subtle signs, such as shortness of breath, indigestion, stomach pain or a general feeling of uneasiness, may be present, but might not necessarily cause the individual to believe that he or she is having a heart attack,” shares Dr. Sayanlar. “More frighteningly, there may be no indications at all, so the individual will go on with their daily activities.”

Silent heart attacks, which account for 45% of all heart attacks, are detectable through a routine check-up and electrocardiogram (EKG) with a primary care physician or cardiologist. According to Dr. Sayanlar, patients with the following risk factors should schedule annual EKGs:

  • High blood pressure
  • High cholesterol
  • Diabetes
  • A family history of heart attacks or heart disease
  • Men in their mid-late 40s
  • Women in their mid-late 50s
  • History of smoking

If an abnormality is noted by an EKG, a patient would likely need a stress test to examine the blood flow to the muscle of the heart. “Your care team will suggest the best test for you,” says Dr. Sayanlar. “You’re not always automatically required to run on a treadmill.” Then, if the results of the stress test are also abnormal, another procedure, such as an angiogram, may be recommended to directly examine the arteries and determine if there are any blockages.

If and once a silent heart attack is found, a patient is diagnosed with coronary artery disease (CAD). Treatment will then aim to prevent further heart attacks and prevent the onset of heart failure through either medication and/or surgery.

Without a check-up, diagnosis and proper care plan, the likelihood of having another episode is extremely high and the magnitude can be devastating, notes Dr. Sayanlar. “Another heart attack can significantly damage the heart muscle and result in congestive heart failure or abnormal heart rhythms. Sometimes, though, it unfortunately can be fatal.”

“If you’re having chest pain, immediately call 9-1-1,” advises Dr. Sayanlar. “And if you have any concerns that you may be facing a cardiac problem, it’s not worth the risk to ignore it. Cardiovascular disease is the leading cause of death for both men and women in the United States. It is better to play it safe and not gamble with your life.”

Dr. Sayanlar practices at Hackensack Meridian Health Medical Group – Cardiology – Advanced Cardiology Institute in Fort Lee (2200 Fletcher Avenue, Suite 1). If you would like to schedule an appointment with Dr. Sayanlar, call 201-461-6200. To find a provider near you, visit

The material provided through Health Hub is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.

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