Not every case of heart disease is as dramatic as what you see on Grey’s Anatomy. In fact, according to a 2017 report from Harvard Health Publishing, some 45 percent of heart attacks are categorized as silent myocardial infarctions (SMIs), meaning that “when they occur, their symptoms lack the intensity of a classic heart attack.” And, according to the Centers for Disease Control and Prevention (CDC), approximately half of all men who die of coronary heart disease have no previous symptoms whatsoever.
But if not every heart disease diagnosis is glaringly obvious, then how are doctors—let alone you—supposed to know if your ticker’s a time bomb? Getting a routine checkup is a good place to start, but it also pays to learn these silent signs of a heart attack so you know if and when to seek emergency treatment.
1- Hot Flashes
Women going through menopause aren’t the only people who experience hot flashes. When Canadian researchers surveyed 1,015 heart attack patients in 2013, they found that approximately 45 percent of men experienced this symptom—both with and without accompanying chest pain.
2- Cold Sweats
Breaking out in a cold sweat could mean more than just a case of nerves. In the same Canadian study, cold sweats were one of the most common symptoms associated with a silent heart attack. Approximately 47 percent of men experienced this symptom, compared to just 40 percent of women.
3- Shoulder Pain
While some men having a heart attack—86 percent, to be exact—experience chest pain as a symptom, others feel the agonizing discomfort of myocardial infarction in their shoulder. In the same 2013 Canadian study, 41 percent of male heart attack patients said that they experienced pain in either their left arm or shoulder.
4- Arm Pain
“A typical heart attacks can have a wide range of presentations,” explains Dr. David Gatz, an emergency physician at Mercy Medical Center in Baltimore, Maryland. “Pain or discomfort will frequently still be a part of the presentation, but may not involve the chest. Examples might include arm or neck pain.”
Indeed, in the Canadian study, 19 percent of men noted that they’d experienced neck pain, and 26 percent noted having pain in both arms at some point.
Toothaches don’t always mean it’s time to schedule a trip to the dentist. Rather, for a surprising number of male heart attack victims—13 percent in the Canadian study, to be exact—tooth pain was one of the silent symptoms of their heart problem.
Since headaches are such a common malady, it’s easy to brush them off as being stress-related or tied to a lack of sleep. However, in some instances, that headache may be an indication of a serious heart issue. In the Canadianstudy, 16 percent of male patients reported experiencing a headache while they were having a heart attack.
A general feeling of lethargy and frailty could mean that you have the flu—or it could indicate that you’re having a heart attack. In the ER, “some [heart attack] patients report more vague symptoms like generalized weakness, while still others report an ominous sensation that they’re going to die,” says Gatz.
According to the American Heart Association, unexplainable fatigue is one of the most common silent signs of heart disease. That’s because when the heart is unable to pump an adequate amount of blood throughout the body, the circulatory system responds by diverting blood away from less vital organs, like the muscles in your limbs. This, in turn, causes the tiredness that patients with heart disease often experience.
9- Throat Pain
“Typical symptoms [of a silent myocardial infarction] like mild pain in the throat or chest can be confused with gastric reflux, indigestion, and heartburn,” explain the editors at Harvard Health. Since so many patients mistake this warning sign for something less severe, they often put off seeing a doctor until their condition has worsened past the point of treatment—making it all the more important for individuals to pay attention to this symptom when it occurs.
10- Pressure in the Center of the Chest
Though most people associate heart disease with pain on the left side of the chest—where the heart is located—it is actually more common for a person experiencing a heart attack to feel pressure or pain in the center.
“Heart attacks most often cause discomfort in the center of the chest, along with a sensation of unremitting squeezing, fullness, or tightness,” cardiologist Dr. Curtis Rimmerman, MD, explained to the Cleveland Clinic.
Feeling sick to your stomach? It could be because that sushi you ate at lunch was past its prime—or it could be a silent sign your heart isn’t working like it’s supposed to. This happens because, during a heart attack, the heart diverts blood away from the digestive system, thereby causing unpleasant gastrointestinal issues.
If you’re experiencing serious lightheadedness, it could be your heart crying out for help. This occurs because, when your heart isn’t working effectively, your major organs—like your brain—are getting less blood and therefore can’t function properly. Usually, you can differentiate dizziness caused by heart disease from less serious lightheadedness thanks to the accompanying symptoms.
13- Shortness of Breath
Unless you’re running a 5K or taking an intense spinning class, you shouldn’t be gasping for air like your life depends on it. “New shortness of breath with exertion can be concerning,” notes Dr. Gatz. If you find yourself short of breath while sleeping or watching TV, this could be because blood is backing up in your pulmonary veins and leaking into your lungs where it shouldn’t be.
14- Back Pain
Pain anywhere in your upper body could be a symptom of heart disease—not just your chest. According to the Cleveland Clinic, when the heart is having difficulty functioning, it activates nerves that can trigger pain elsewhere in the body. So, if you’re dealing with discomfort in your back and you can’t explain why, it might be time to get your heart checked out—just to be safe.
15- Difficulty Sleeping
Sleep problems aren’t just a risk factor for heart disease—they’re also a symptom. The shortness of breath and heart palpitations often associated with heart disease are a frequent precursor to sleep disturbances like sleep apnea, orthopnea, and insomnia in the months leading up to a heart disease diagnosis. The good news? Those sleep disturbances usually subside once their root causes are treated.
Feeling confused isn’t necessarily a sign that something’s amiss with your brain. According to the American Heart Association, heart failure directly impacts how much sodium is in your blood, and this, in turn, can lead to confusion and impaired thinking.
You can once again thank impaired blood flow for this subtle heart attack symptom. Because a heart attack causes the blood vessels throughout the body to narrow, it limits the amount of blood your extremities receive and therefore causes them to go numb.