Rise in cases of asymptomatic heart attacks amongst middle aged people

By Dr. Naveen Bhamri in Cardiac Sciences

Nov 08 , 2020 | 4 min read


Asymptomatic heart attacks medically known as silent myocardial infarction (SMI) annually accounts for around 45-50% of morbidities due to cardiac ailments and even premature deaths in India. The incidences among middle aged people experiencing SMI is twice likely to develop in males than females. The symptoms of SMI being very mild in comparison to an actual heart attack; it is described as a silent killer. Because sometimes there is no cardiac arrest symptoms. Unlike the symptoms in a normal heart attack which includes extreme chest pain, stabbing pain in the arms, neck & jaw, sudden shortness of breath, sweating and dizziness, the symptoms of SMI are very brief and hence confused with regular discomfort and most often ignored.

Risk Factors

The risk factors are same as that of classic heart attack. It includes:

  • Age
  • Family history
  • Smoking or chewing tobacco
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Weight issues
  • Lack of physical activity

Asymptomatic heart attacks in middle aged people

If a patient under 40 years of age experience symptoms like Shortness of breath, chest pressure, cold sweats, which usually are the symptoms of a heatstroke, asthma or an emotional outburst, it should seldom be ignored or misinterpreted. Immediate diagnosis and consultation becomes mandatory to avoid any further complications. Mortality rate due to heart attack doubles if the patient has already suffered from a SMI.

Several studies have speculated that due to excessive stress and lifestyle changes, the younger generation is more vulnerable to certain undetected cardiac disorders like arrhythmic pumping; premature heart ailments that often end up in sudden cardiac events.

In India, it has been estimated that one in every four death is attributed to ignorance of the mild symptoms and is one of the leading causes of mortality among both males and females (between 35-45 years). Asymptomatic heart attacks usually shows symptoms in the early 20’s and 30’s which becomes fatal around the age of 40 years, and hence timely intervention can help in such circumstances.

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Causes of Sudden Cardiac Death (SCD) apart from Heart Attack

There are two different but equally dangerous causes of heart disease which can cause a heart attack in both men and women under age 40.

  • 1. Kawasaki disease: It is one of the rarest diseases that develop during childhood, involving inflammation of the arteries, veins and the capillaries. At certain point of time, the disease affects the coronary arteries that carry oxygen rich blood to the heart. The condition is very difficult to detect in the early stages and mostly diagnosed post heart attack.
  • 2. Hypertrophic cardiomyopathy: It is the most common cause of SCD among the young people including athletes and most of the time it may be genetic. It is caused due to a genetic mutation in the heart muscles that causes enlargement of the cardiac muscles causing the walls of the ventricles to thicken. This restrict the blood flow as the ventricles works with higher pressure to pump the blood throughout the body, making it unsafe for the person by restricting any physical activity, and may lead to a sudden collapse.

Increased dependence of the middle aged people (both men and women) on smoking and binging on alcohol is responsible for premature heart problems. Sedentary lifestyle, poor eating habits and lack of physical activity is highly linked to obesity and thereby causing heart problems.

Elderly people are more affected with heart attacks, but now a days trend is changing and these ailments related to heart is on the rise among younger generation too. Even though inherited conditions cannot be controlled but making changes to the lifestyle choices can make a big difference.

Silent Heart attack symptoms

The symptoms may be similar to normal heart attack but is accompanied by usual symptoms that can damage the heart muscles and raise the risk of occurrence of future attacks. The following symptoms should never be ignored -

  • Mild discomfort in chest, arms, or jaw that goes away after resting
  • Shortness of breath and tiring easily
  • sleep disturbances and increased fatigue
  • Abdominal pain or heartburn
  • Skin clamminess

Any person undergoing a silent heart attack may feel more fatigue than before even after normal physical activity and a regular physical exam becomes mandatory to stay on top of heart health.

Treatment after Silent Heart Attack

A patient should always be aware of the two complications associated with SMI is that they are succumbed to coronary Artery disease (CAD) and Sudden Cardiac Death (SCD). And the related treatment should be done on time with the best heart hospital in Delhi without depending on the severity of CAD to develop. The treatments is aimed at preventing further complications like onset of ischemia, heart failure and mortality due to cardiac arrhythmias with the use of medication, revascularization using stents and even bypass surgeries.

Doctors may advise a stress test that can solve two purposes. It allows the doctor to measure the threshold of exercise that can produce ischemia to prescribe specific instructions related to the safest activities to be performed. Secondly if ischemia occurs during the stress test, the person already affected with silent heart attack, will experience a certain type of angina. And hence the test can provide important feedback for patients suffering from SMI and allow doctors with better treatment options.