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Despite popular depictions, heart attacks do not always strike with a big bang. The subtler types are commonly referred to as “silent heart attacks”. A silent heart attack, also known as a silent myocardial infarction (SMI), is said to account for 45 percent of heart attacks and strike men more than women.

They are described as “silent” because when they occur, their symptoms lack the intensity of a classic heart attack, such as extreme chest pain and pressure; stabbing pain in the arm, neck, or jaw; sudden shortness of breath; sweating, and dizziness.

“SMI symptoms can feel so mild, and be so brief, they often get confused for regular discomfort or another less serious problem, and thus men ignore them,” said Doctor Jorge Plutzky, director of the vascular disease prevention program at Harvard-affiliated Brigham and Women’s Hospital.

For instance, men may feel fatigue or physical discomfort and chalk it up to overwork, poor sleep, or some general age-related ache or pain.

Other typical symptoms like mild pain in the throat or chest can be confused with gastric reflux, indigestion, and heartburn.

Speaking to Harvard Health, Doctor Plutzky said: “People can even feel completely normal during an SMI and afterward, too, which further adds to the chance of missing the warning signs.”

The silent epidemic

The number of people who suffer an SMI and don’t realise it is alarming.

A study published in the journal JAMA looked at almost 2,000 people ages 45 to 84 (half of whom were men) who were free of cardiovascular disease.

After 10 years, eight percent had myocardial scars, which are evidence of a heart attack.

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Most surprising was that 80 percent of these people were unaware of their condition.

Overall, the prevalence of myocardial scars was five times higher in men than in women.

Research published elsewhere suggests a higher pain threshold may be the reason for some people not noticing the symptoms of a heart attack but more research needs to be done to help us understand what’s causing others to miss the signs.

The Norwegian study also found silent heart attacks happen more in women, suggesting women’s pain tolerance might help to explain why so many don’t realise they’re having a heart attack.

More than 4,000 adults placed their hands in ice-cold water for as long as possible to find out their pain threshold.

Researchers found that those who had had a silent heart attack – eight percent of participants – kept their hand in the water for much longer than the 4.7 percent of participants who had recognised their heart attack pain.

Whilst female participants had experienced less heart attacks than men, a large proportion of those were silent – 75 percent compared to 58 percent in men.

The study offered insight into why this might have been, as more women (38 percent) absorbed the cold pressor test than men (23 percent).

According to Harvard Health, SMI and regular heart attacks share the same risk factors: smoking, being overweight, lack of exercise, high blood pressure, high cholesterol levels, and diabetes.

They can be just as dangerous, too.

“SMI often leaves scarring and damage to the heart, which, combined with the fact that many people who have an SMI don’t seek immediate care, can further raise a person’s risk of a second and potentially more harmful heart attack,” warned Doctor Plutzky.

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