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4 silent heart attack symptoms to never ignore

July 23, 2020 (Updated: August 3, 2021)
Lily Moran

What a difference a word makes. In this case, it can be the difference between life and death. Just remove the word “sudden” from “sudden cardiac arrest (SCA).”

You’re still left with cardiac arrest (CA), a mortal danger for millions of people.

But you can feel a bit less apprehensive.  Because we now know that CA (including SCA) can be avoided with just a little insight.

Learning more about the warning signs your body sends you can help you stay steps ahead of the possibility of CA, reducing your risk.

Warning: CA ahead

Recent research found that a month or so prior to their SCA, around half of the victims experienced what we now know can be warning signs, most importantly:

  • Chest pain
  • Leg pain
  • Shortness of breath
  • Lightheadedness

But, can’t those be symptoms of something other than CA?

Yes—these all can signal a number of conditions.

So we’ll try to help you rule CA in or out, for each symptom.

Please pay close attention—even closer if you already have known risk factors for cardiovascular disease, such as:

  • Hypertension
  • High cholesterol
  • Diabetes
  • Advanced age
  • Personal or family history of cardiovascular problems

About Chest Pain

Tightness or pressure in your chest can be a sign of:

  • A heart attack in progress or coming soon
  • Blockage in one or more coronary arteries that puts you at risk of a future heart attack

It can be caused by:

  • Blockages and narrowing of the heart arteries, causing reduced blood flow to the heart
  • Inflammation of the lining of the heart or the heart itself

This kind of chest pain—often a “squeezing” sensation in the left side or center of the chest, is called angina.

If it happens only after exertion, and goes away with a few minutes of rest or after using a nitroglycerin tablet or spray, it’s called stable angina.

If it persists, is more intense, or comes and goes regardless of your activity, it’s likely unstable angina, a health threat—and reason for an ER visit right away, says David S. Majdalany of the Adult and Congenital Heart Disease Center at Cleveland Clinic.

Leg Pain

Leg pain, usually in the calf or thigh, can be caused by:

  • Muscle strain or joint problems, such as arthritis
  • A serious circulation problem called peripheral artery disease (PAD), which causes blockages that affect the blood vessels outside the heart and brain

How to tell PAD from arthritis? PAD-related pain usually occurs during or after activity, then improves with rest.  Arthritis pain, on the other hand, can strike at any time, and won’t always improve with rest.

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Chronic Inflammation Decoded

Other PAD symptoms can include:

  • Cold hands and feet
  • Wounds that aren’t healing
  • Ulcers
  • Gangrene

Untreated PAD symptoms can worsen, making exercise, even walking, difficult. If that happens, here comes weight gain, the last thing most people need.

That can lead to circulation problems as dire as gangrene and the loss of a limb.

Shortness of Breath

Unusual or unexpected difficulty catching your breath after exertion can be caused by:

  • Lung or heart disease
  • Sleep apnea
  • Obesity
  • Poor physical condition

If you’re gasping and winded after activities you used to do easily, get checked soon.  That’s a common symptom of heart attack as well as heart failure.


Feeling lightheaded or dizzy, out of nowhere, can be a sign of heart attack or heart failure underway—or the risk of them in the future.  But it can also signify low blood pressure or other less threatening conditions.

Causes include:

  • Fluctuations in blood pressure
  • Dehydration
  • Irregular heartbeat
  • Inner-ear/vestibular problems
  • Anxiety
  • Neurologic problems

Depending on severity and frequency, these all might call for investigation.

Just say no to “sudden”

The best preventive, of course, is to avoid unhealthy habits to begin with—the usual suspects like smoking, eating dangerous trans fats, too much sugar or alcohol.

Instead, a diet rich in fruits and vegetables, lean proteins, and complex carbohydrates from whole grains, and at least a little movement away from sedentary are a healthy heart’s best friends.

But we agree with Dr. Majdalany that cardiovascular health is about more than healthy lifestyle.

It’s about recognizing changes in your day-to-day health—and reporting them to your doctor. Unaccustomed chest or leg pains, shortness of breath and lightheadedness are not part of “just getting old.”

Pay attention to yourself.  Any symptoms, get checked.


Disclaimer: Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Last Updated: July 23, 2020
Originally Published: August 26, 2016

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