Dr Prabhu Dev
6 min readNov 13, 2021


‘Silent’ heart attacks!

Friends my advice, — Be large Hearted. Don’t have an enlarged heart!

Having a big heart is appreciated. But an enlarged heart is usually due to IHD with a heart attack, high BP, Heart valve diseases, dilated cardiomyopathy and viral infections. Hearts are often described as the size of a human fist. An enlarged heart indicates failure of the heart muscle to pump blood efficiently.

A man clutches his chest and collapses in pain. A chest-clutching collapse is a clear warning sign. I am sure He’s having a heart attack. The pain in your heart and chest can quickly travel to the arms and shoulders, if he appears anxious, has cold sweats is breathless- It is for sure a heart attack!

Are all heart attacks so dramatic?

No, they are not! Nearly 30 to 40% of all heart attacks show none of the above symptoms. They are called as Silent heart attacks! The Heart attack you never knew you suffered! The damage is done, but you are not aware of it.

Detecting a silent heart attack is difficult because the usual symptoms are either absent or minimal. So, patients often don’t consult their doctor and consequential damage goes unrecognised and untreated.

Diabetics, in particular, are frequently affected by silent heart attacks due to neuropathy numbs the nerve endings.

Most heart attacks today are not fatal. Technological advancement in the medical field has come as a big relief for heart patients. Today, more than 90% of people survive Heart Attacks- Tens of thousands survive heart attacks and go on to lead productive, enjoyable lives.

Growing use of aspirin, clot-busting drugs, and artery-opening angioplasties and stent placements in the early stages of a heart attack account for 70 to 80% reduction in the deaths.

I must warn you here that even Healthy looking people can have heart attacks — fitness Icon punith Raj Kumar, siddarth Shukla the actor, Bob Harper the fitness guru to name a few! Heart attacks can happen to almost anyone — no matter what age, gender or fitness level. You’re in your 20s, 30s or 40s you can still have a heart attack!

Hello friends

I am Dr Prabhudev

Former director sri jayadeva institute of cardiology

Former Vice Chancellor Bangalore University

Former chairman state health commission

Let me share my thoughts with all of you on Silent Heart Attacks!

Silent heart attacks and “Silent ischemia” refers to the presence of objective findings suggestive of myocardial ischemia or infarction but without the classical symptoms!

Can ECG tell us about silent heart attacks?

Yes. In fact most silent heart attacks are detected by an ECG. An ECG can potentially reveal that you had a heart attack years ago without knowing it. ECG shows the abnormal patterns of electrical activity suggest that part of your heart may have been damaged from a heart attack.

Chest pain on effort has long been considered the cardinal symptom of myocardial ischemia. Silent heart attacks, in a study published in May 2016, nearly 30 to40% of heart attacks were silent. They can only be detected by an electrocardiogram -ECG. Routine ECG readings help recognizing a silent heart attack that has occurred a few months or even a few years back.

Some wonder if silent attacks are Real heart attacks! Take it from me Silent heart attacks are indeed true heart attacks. Never underestimate silent heart attacks. They are as bad as or may even be worse than heart attack with symptoms.

Heart attacks have been the major cause of death across the world. High blood pressure, high blood cholesterol, and smoking are key risk factors. Diabetes, Overweight and obesity, Unhealthy diet, Physical inactivity, Excessive alcohol are some of the other risk factors.

Strange but statistically true!

Many heart attacks happen on Monday mornings- 20 percent higher on Mondays. May be the pressure of going to work. May be excessive intake of alcohol in the weekend!

Saturday ranks second. Sundays had the least numbers of attacks.

Most heart attacks hit during the early morning hours between 4 AM and10 a.m.

People who live alone are twice as likely to have a heart attack compared to those living together!

Negative emotions- worries, anxiety and fear are risk factors for heart attack.

Laughter is a good medicine for the heart!

Now let me present some hard core Heart Attack facts

· Someone suffers a heart attack every 40 seconds in India

· Every 36 seconds, a person dies from cardiovascular disease

· 10 Million People or one crore suffer heart attacks every year

· We see More than 10 lakh cases of cardiac arrest in a year.

· Two in five heart attacks are silent.

· Silent heart attacks are also real heart attacks

· Coronavirus pandemic has doubled the chances of death from heart attacks.

· Heart disease has remained the leading cause of death for over two decade now

· Heart disease is the leading cause of death

Silent heart attacks are definitely more common than we think. It is more common in men than in women. But fatality is more in women. In addition, following a silent heart attack, the risk of dying due to repeat — heart attack or heart failure is three times higher. The cumulative risk of death rises to 34 percent.

Many have vague symptoms such as feeling generally unwell accompanied by back pain, dizziness, indigestion. Often mistaken for gastric acid reflux into the oesophagus

Heart attacks are, essentially, a coronary circulation problem. They occur when blood flow to the heart is severely reduced or blocked. Heart attacks can be relatively mild or moderate or very serious. The heart may continue to beat normally but if the blockage is not quickly resolved, parts of the cardiac muscle will begin to die from lack of oxygen and nutrition. The longer a heart attack goes on without treatment, the greater the damage to the heart muscle.

Now the important question- How can I prevent a silent heart attack?


General — Go for Heart-healthy diet, Go for aggressive diabetes control, normalise BP, Work toward a healthy weight, manage stress, be physically active and quit smoking.

For people at high risk with high sugar levels, high BP, high cholestrol strong family history or who are suspected of having had a silent heart attack, we recommend an ECG, an imaging test- a resting echocardiogram, nuclear uptake studies and a stress test.

I would advise them to have an ECG every three months to detect a possible silent attack. It takes only 10 minutes to have an ECG done!

Here are Some surprising signs of heart attack that you may not be aware of — Sexual Dysfunction, Male Pattern Baldness, sleep apnoea, Shortness of breath, general weakness, Nausea or vomiting, Dizziness and unexplained fatigue!

When you see the above symptoms have an ECG!

An ECG can potentially reveal if you have had a heart attack months or even years before!

An ECG can potentially predict a future risk of heart attack by uncovering graphic abnormalities in the electrical activity of your heart

Now how to live with Silent heart attack!

If you’ve had a silent heart attack, without adequate and appropriate treatment of the risk factors and necessary lifestyle changes you are at higher risk of having repeat heart attack. This one will likely be more severe and harmful and may develop even heart failure.

Some think a silent heart attack is better than an attack with symptoms. Wrong! Silent attacks delay the remedy and increase the risks. Knowing you’re at risk of a heart attack can be emotionally distressing. Not knowing can have much more serious consequences, prompting you to continue living in ways that endanger the health of your heart and your life.

Normally, silent heart attacks are detected long after the heart attack is over. Treatment will mostly involve taking medicines to improve blood flow to your heart, prevent clotting, control sugar and cholesterol and life style changes.

Who should be tested?

‘Ones with serious or high risk actors’

Ones with a strong family history

Ones who have had a silent attack

What Tests?

Blood tests: High levels of high-sensitivity C-reactive protein or homo-cysteine in the blood may suggest a higher cardiovascular risk in a select group of people. Elevated levels of Lp (a) are a strong risk factor for having a heart attack due to atherosclerosis.

A recent study in India has showed that high Lp(a) levels — defined as >50mg/dl) increased risk of coronary artery disease in younger people by 2 to 3-fold.

For the molecular footprints of troponin T, a protein released by injured heart cells suggest vulnerability to heart attacks.

ECG and imaging tests

Stress tests

Nuclear uptake studies

May require Coronary angiogram and intervention

Now what is the Message!

Do not take heart for granted. Silent heart attacks are real heart attacks. Do not wait for heart to suffer. Do not compromise heart’s life-sustaining ability. Acknowledge the presence of risk factors and take preventive measures to bring them under control before it’s too late.



Dr Prabhu Dev

Former director of Sri Jayadeva Institute of Cardiology, Former VC of Bangalore University and former chairman of the Karnataka State Health Commission