In recent years, cardiovascular disease has been the leading cause of death both in Malaysia and around the world. In conjunction with World Heart Day today, Malaysians are encouraged to look after their cardiovascular health by knowing the possible dangers of silent heart attacks, and how one can be swiftly spotted and prevented.

Silent heart attacks, known as silent myocardial infarction, account for 45% of heart attacks. They are described as such because they occur without the usual, recognisable symptoms of a heart attack, which include chest pain or the feeling of pressure; radiating pain in the arm, neck or jaw; sudden shortness of breath; sweating and dizziness.

“Many patients dismiss the early warning symptoms as simply indigestion, nausea, sweating, or feeling tired,” says Dr Patrick Tiau, consultant cardiologist at Sunway Medical Centre, Sunway City.

“By the time they seek medical treatment, they are shocked to learn that what they experienced was actually due to reduced blood flow to their heart, which caused them to have a silent heart attack.”

Silent heart attacks can lead to more serious health complications, including the risk of another heart attack or even failure, if left untreated.

When assessing risk factors among various demographics, two types come into play: non-modifiable and modifiable, i.e. through lifestyle adjustments.

Non-modifiable risk factors

• Age: The risk of experiencing a silent heart attack increases as an individual grows older.
• Gender: According to a 2021 study, men are more susceptible to silent heart attacks, but women are more prone to a higher risk of complications after experiencing one, especially if they are diabetic.
• Genetics: Those with a family history of heart disease are at higher risk.

Modifiable risk factors

• Smoking: Chemicals in cigarettes stimulate one’s heartbeat and can dramatically increase one’s risk of heart attack.
• High cholesterol: Elevated cholesterol levels can lead to formation of plaque in the blood vessel, which reduces flow to the heart.
• High blood pressure: This puts extra strain on the heart muscle which, over time, causes it to stiffen, thicken, and perform less optimally.
• Body weight: Individuals who are overweight or obese, especially when their weight tends to sit at the waist, are more likely to develop heart disease.
• Physical inactivity: Doing regular exercise helps protect the heart by keeping other risk factors in check, including cholesterol, blood pressure, diabetes, and obesity.

Preventive measures

Whether it’s a common or silent heart attack, making small changes to one’s daily lifestyle can go a long way in reducing risk factors. These include:

• regularly monitoring blood pressure and cholesterol;
• getting sufficient aerobic exercise;
• quitting smoking; and
• eating a balanced diet.

Most importantly, inform a doctor as soon as possible if you experience unusual symptoms, as this could help diagnose silent heart attacks through specialised testing, such as with an ECG, echocardiogram, CT coronary, or angiograms, as well as cardiac markers and exercise stress testing.

Post-heart attack care

For those who have already experienced a silent heart attack, Tiau emphasises the importance of thorough cardiac evaluation and risk optimisation, which include taking the necessary prescribed medications. These may include aspirin, statin, and others such as beta blockers and ACE inhibitors.

Tiau also acknowledges the mental impact of silent heart attacks that some may encounter. “After the stress of the initial diagnosis and recovery, you may develop feelings of shock, sadness, and anxiety,” he said, explaining that these are normal and can be overcome with the right support.

“Some people find it helpful to join a support group where they can talk with others who have been through a similar experience, or seek out companionship and encouragement. Others might turn to avenues such as the gym or yoga classes,” he added.