#HEALTH: World Heart Day - Silent Heart Attacks

29 September 2022

Cardiovascular disease remains the leading cause of death in Malaysia. Picture: Jcomp - Freepik.com

In many instances, silence denotes a sense of calmness and tranquillity.

This is not the case however when it comes to health.

Silence could mean something dangerous is brewing beneath the surface, something we may not notice in time.

Dr Tiau says nearly half of all heart attacks are mistaken for less serious problems and this can increase the risk of death.A case in point is the possibility of a silent heart attack. Silent heart attacks, known as silent myocardial infarction (SMI), account for 45 percent of heart attacks.

They are described as "silent" because they occur without the usual, recognisable symptoms of a heart attack.

This has led to many not knowing that they experienced a heart attack until they receive diagnosis days or weeks after.

Silent heart attacks can lead to a myriad of more serious health complications if left untreated over an extended period such as heart failure. If further neglected, it could also lead to an increased risk of another heart attack, which could potentially be deadly.

Typical symptoms of a heart attack include chest pain, often described as a heavy or pressure sensation; radiating pain in the arm, neck, or jaw and sudden shortness of breath.

Sunway Medical Centre consultant cardiologist, Dr Patrick Tiau, says cardiovascular disease remains the leading cause of death in Malaysia and globally too.

"A key factor in this is that nearly half of all heart attacks are mistaken for less serious problems and this can increase the risk of death.

Many patients tend to dismiss the early warning symptoms as tiredness, indigestion, nausea or sweating. By the time they seek medical treatment for these symptoms, they are shocked to learn that what they are experiencing is actually due to reduced blood flow to the heart and that has caused them to have a silent heart attack.

When assessing risk factors in different demographics, Dr Tiau explains that we can generally get a clearer picture by looking at two categories: non-modifiable risks versus modifiable risks.

Factors that Cannot be Changed (Non-modifiable)


The risk of experiencing a silent heart attack increases as an individual grows older.


According to a 2021 study, men are more susceptible to incidents of silent heart attacks than women. However, women are more prone to a higher risk of complications after experiencing one, especially if they are diabetic.


People with a family history of heart disease are at increased risk of a heart attack.

Factors that Can be Changed (Modifiable)


Chemicals in cigarettes stimulate one's heartbeat and can dramatically increase one's risk of a heart attack.

High cholesterol

Elevated cholesterol levels can lead to the formation of atherosclerotic plaque in the blood vessel and reduce blood flow to the heart.

High blood pressure

Having high blood pressure puts extra strain on the heart muscles 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 even if they do not have any other risk factors.

Physical inactivity

Doing regular exercise helps protect the heart by keeping other risk factors in check, including cholesterol, blood pressure, diabetes, and obesity.

Prevention Advice from Cardiologist

As with many critical illnesses, Dr Tiau advises Malaysians to first and foremost take preventative measures.

"Undeniably, heart health is essential to allow us to have a well-balanced and fulfilling life.

The heart itself is the first and last sign of life that is responsible for, quite literally, keeping us going."

In combating heart attacks, the most important thing to remember is that prevention is definitely better than cure, he adds.

Whether it's a common or silent heart attack, even making small changes to our daily life can go a long way in reducing one's risk factors.

This includes regularly monitoring of blood pressure and cholesterol; getting sufficient aerobic exercise; quitting smoking; eating a balanced diet of fruit, vegetables, lean meat and whole grains, and ensuring one's blood pressure, cholesterol and blood sugar are all well-controlled.

Most importantly, informing a doctor as soon as possible about any unusual symptoms can help diagnose silent heart attacks through specialised testing.

For patients who have experienced a silent heart attack, Dr Tiau emphasises the importance of a thorough cardiac evaluation and cardiac risk optimisation, which includes the necessary prescribed medications.

"Once you go home from the hospital, it is essential that you keep taking your medications, as these will ensure your heart health is kept in check, possibly for the rest of your life."

The mental side of silent heart attacks also needs to be addressed. After the stress of the initial diagnosis and recovery, you may start to develop feelings of shock, sadness, and anxiety, explains Dr Tiau.

This is normal, and it's important to remember that these feelings will pass 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 through avenues such as the gym, or yoga classes.

A heart attack is one of the most daunting things a person can go through and what makes it even more so is that heart attacks can happen without us even realising it.

However, by educating ourselves through the right medical channels and by making sure we go for regular medical check-ups, we can ensure that our hearts remain strong for years to come.

Source: New Straits Times