For many people, the first sign of coronary heart disease (CHD) is a heart attack. By then, it’s often too late. CHD can quietly build up, sometimes over several decades, until a heart attack occurs.
When a heart attack takes place, it doesn’t always announce itself. About one in five heart attacks are silent.1 Moreover, most heart attacks happen to people who have never had one before. Roughly 605,000 of the 805,000 heart attacks in the U.S. each year are first-time events.1 Knowing the signs of a silent heart attack and your own cardiovascular risk is essential to prevention.
A silent heart attack, or silent myocardial infarction, is when blood flow to part of the heart muscle is severely reduced or blocked and causes damage, with no symptoms, mild symptoms, or symptoms not typically associated with a heart attack.2 Silent ischemia is often a precursor to a heart attack and describes a shorter period of reduced blood flow (before permanent tissue damage takes place).3 Because silent attacks are unsuspecting, they are often confirmed after the damage is done through an electrocardiogram (ECG) or imaging.
During a silent attack, traditional symptoms like chest pain are often absent. Instead, symptoms tend to be subtle or easy to attribute to something else, including a flu-like feeling, soreness in the chest or upper back muscles, aching in the jaw, arms, or upper back, fatigue, and indigestion.2
Knowing the signs of a silent heart attack can help you take action before irreversible damage occurs. However, the best form of avoiding the consequences of a silent heart attack is prevention. Take steps to identify your risk for a cardiovascular event and work with your physician to establish appropriate interventions.
Preventing a first heart attack remains the ultimate goal. However, conventional approaches tend to flag risk only after measurable changes appear, such as rising cholesterol, high blood pressure, or plaque visible on imaging. Standard risk calculators also rely on a limited set of factors and may not fully reflect lifestyle and environmental exposures, so some at-risk patients appear healthy.
Scientific advances now make it possible to combine genetic (inherited) markers with epigenetic (acquired) markers, which are chemical changes to DNA shaped by lifestyle and environmental factors such as smoking, stress, and inflammation. Together, these give a more complete picture of cardiovascular risk and help physicians tailor interventions, such as lifestyle guidance, medication, and monitoring, with greater precision.
Traditional, one-size-fits-all diagnostics have limits. Our physician-ordered test, Epi+Gen CHD™, integrates genetic and epigenetic information to deliver more individualized insight than conventional risk assessment alone.
Epi+Gen CHD™ is a clinical blood test that evaluates genetic and epigenetic biomarkers to estimate a patient’s likelihood of a coronary heart disease event, including a heart attack, in the next three years. It helps physicians:
Identify heart attack risk in patients who have not previously been diagnosed with coronary heart disease.
Build prevention strategies tailored to each patient’s molecular profile.
Intervene earlier to lower the chance of a first heart attack, silent or otherwise.
Silent heart attacks demonstrate why waiting for symptoms isn’t enough. By improving access to rapid treatment, refining diagnostic tools, and prioritizing prevention, we can change the trajectory of heart disease. Primary care physicians can play a significant role in driving access. By bringing precision cardiovascular medicine solutions into primary care, individuals can better understand their risk, without requiring a specialist referral. Learn more about how Epi+Gen CHD helps physicians and their patients measure coronary heart disease event risk.
Yes. A silent heart attack can have no symptoms, mild symptoms, or symptoms that aren’t recognized as a heart attack.2
It may feel like nothing at all, or include unconventional symptoms like the flu, indigestion, fatigue, or a sore muscle in the chest or upper back.2
Yes. High blood pressure is only one risk factor. Family history, cholesterol, smoking, stress, and physical inactivity, among many other factors, also affect your overall risk of an event.4
Yes. Most heart attacks involve obstructed coronary arteries, but a form known as Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) accounts for an estimated six to 15 percent of all acute coronary events.5
Centers for Disease Control and Prevention (CDC). “Heart Disease Facts.” 2022.
Silent heart attack. Cleveland Clinic. Updated June 25, 2024. Accessed October 22, 2026. https://my.clevelandclinic.org/health/diseases/21630-silent-heart-attack
Ischemic heart disease and silent ischemia. American Heart Association. Updated December 11, 2024. Accessed October 22, 2026. https://www.heart.org/en/health-topics/heart-attack/about-heart-attacks/silent-ischemia-and-ischemic-heart-disease
My blood pressure is normal, can I still have a heart attack? Manhattan Cardiology. Published June 2, 2023. Accessed October 22, 2026. https://manhattancardiology.com/blog/my-blood-pressure-is-normal-can-i-still-have-a-heart-attack/
Pacheco C, Coutinho T, Bastiany A, et al. Canadian Cardiovascular Society/Canadian Women’s Heart Health Alliance clinical practice update on myocardial infarction with no obstructive coronary artery disease (MINOCA). Can J Cardiol. 2024;40(6):953-968. doi:10.1016/j.cjca.2024.02.032
Article clinically reviewed by Dr. Robert Philibert.
