Think you know what you’d feel like if you were having a heart attack? Think again.

Silent heart attacks, known as a silent myocardial infarction (SMI), account for 45 percent of heart attacks. And they are more likely to strike men than women.

These heart attacks are mistaken for less serious problems, increasing your risk of dying.

Don’t be one of those people who waits too long before getting help. Knowing the signs and taking them seriously can save your life.

What Is a Silent Heart Attack?

These types of heart attacks are described as "silent" because when they happen, their symptoms may not seem like a classic heart attack. There may be no extreme chest pain and pressure. No stabbing jaw, neck or arm pain. No overwhelming sudden shortness of breath, dizziness or sweating.

Symptoms can pass quickly and feel mild, but silent heart attacks damage your heart and can lead to life-threatening problems. Silent signs may include:

• Fatigue or an ache or pain
• Mild pain in the throat
• Mild pain in the center of the chest

The symptoms can easily be confused with indigestion or general aches or pains, leading men to ignore them. But a silent myocardial infarction is just as dangerous as other heart attacks. And with silent heart attacks, people often don't get treatment. That can lead to another potentially more harmful attack, says Harvard Health. 

Let your doctor know if you think you may be having symptoms. You can decide together if you need to have testing or see a heart specialist.

What Can You Do to Keep Your Heart Healthy?

Take it seriously. Heart disease is the leading cause of death in the U.S. The best ways to protect yourself are awareness and prevention.

Do what you can to lower your risk. The risk factors for silent heart attacks are the same as any other heart attack. They include smoking, being overweight and not exercising. Health conditions like high blood pressure and high cholesterol levels raise your risk, as does diabetes. Getting those health problems under control is important for your overall health and safety.

To lower your risk:

• Know the signs of a heart attack.
• Keep your weight, blood pressure and cholesterol in a healthy range.
• Talk to your doctor about those numbers and ask if medication is needed.
• Don’t smoke or use tobacco.
• Limit alcohol use.
• Try to exercise most days of the week.

Don’t skip preventive health care. It's important to catch health problems early when they're more treatable. But men tend to go to the doctor less often than women for annual checkups, says the Mayo Clinic.  

Skipping preventive exams and screenings means men are less likely to find out if they have damage called myocardial scars from a silent heart attack. One study found that 80 percent of people who had myocardial scarring were not aware of it.  And the study found that men were five times more likely to have myocardial scarring than women.

Regular preventive care also includes important tests for cholesterol, blood pressure and blood sugar. Those tests help gauge heart health. Regular checkups also help you find out about other important health issues like prostate cancer.

Don’t assume you’re too young to worry about it. Some men with a family history of early heart attacks can be at risk as early as their 30s or 40s. Learn your family history and talk to your doctor about it.

Ask for help. If you’re feeling depressed, don’t ignore it. Depression is linked to heart disease. Many men try to mask depression by self-medicating or with other unhealthy behaviors rather than getting help. If you’ve consistently been feeling sad or hopeless for longer than a few weeks, talk to your doctor.

Manage stress. Stress can raise your blood pressure. Extreme stress can be a "trigger" for a heart attack. And some ways people cope with stress, like overeating, excessive drinking and smoking, are also bad for your heart. Better ways to address stress: working out or other active hobbies, listening to music, getting outdoors, and meditation.

Control diabetes. Having diabetes doubles your risk of heart disease says the U.S. National Library of Medicine.  That’s because high blood sugar from diabetes can harm your blood vessels and the nerves that control your heart. It is vital to get tested for diabetes, and if you have it, to keep it under control.

Make time for sleep. Not getting enough sleep can also raise your risk for high blood pressure, obesity and diabetes. And all of those can increase your risk for a heart attack. Most adults need at least seven hours of sleep per night. If you regularly have sleep problems, talk to your doctor.

Take steps to protect your heart and health now. And if you ever think you might be having a heart attack, don’t hesitate. Call 911 right away.

Sources: The danger of “silent” heart attacks,  Harvard Medical School, 2020; Heart Disease Facts,  Centers for Disease Control and Prevention, 2024; About Men and Heart Disease,  CDC, 2024; Men's health: Checkups, screenings key,  Mayo Clinic, 2022; Cleveland Clinic Survey Reveals Men’s Top Health Concerns as They Age,  Cleveland Clinic, 2022; Preventing Heart Disease,  CDC, 2024; Strategies to Prevent Heart Disease,  Mayo Clinic, 2023

Originally published 5/3/2021; Revised 2023, 2024