Can you have normal blood pressure and have a heart attack

About half of all heart attacks are mistaken for less serious problems and can increase your risk of dying from coronary artery disease.

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About half of all heart attacks are mistaken for less serious problems and can increase your risk of dying from coronary artery disease.
SMI: Unaware of possible danger
How to get checked out
When to see a doctor
What to do if you see someone who might be having a heart attack
From Mayo Clinic to your inbox
Risk factors
Complications
The Mayo Clinic experience and patient stories
In my own words: Heart health for myself and my family
What are the 4 signs of an impending heart attack?
How do you know if you've had a silent heart attack?
How can you rule out a heart attack at home?

You can have a heart attack and not even know it. A silent heart attack, known as a silent myocardial infarction (SMI), account for 45% 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," says Dr. 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.

Also, the location of pain is sometimes misunderstood. With SMI, you may feel discomfort in the center of the chest and not a sharp pain on the left side of the chest, which many people associate with a heart attack. "People can even feel completely normal during an SMI and afterward, too, which further adds to the chance of missing the warning signs," says Dr. Plutzky.

SMI: Unaware of possible danger

The number of people who suffer an SMI and don't realize it is alarming. A study in the Nov. 10, 2015, Journal of the American Medical Association looked at almost 2,000 people ages 45 to 84 (half of whom were men) who were free of cardiovascular disease.

After 10 years, 8% had myocardial scars, which are evidence of a heart attack. Most surprising was that 80% of these people were unaware of their condition. Overall, the prevalence of myocardial scars was five times higher in men than in women.

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," says Dr. Plutzky. In fact, people who have an SMI and don't get treatment have a three times greater risk of dying from coronary artery disease. "A silent heart attack is a loud signal your body sends that you have some kind of underlying health issue that needs attention," says Dr. Plutzky.

How to get checked out

Men may not be aware they had an SMI until weeks or even months later when they see their doctor for a regular visit, or because of persistent symptoms like fatigue, shortness of breath, or heartburn.

SMI is usually detected from an electrocardiogram (EKG) or echocardiogram, which can highlight heart muscle damage. Another method is a blood test for the molecular footprints of troponin T, a protein released by injured heart cells. That test is often used in emergency departments for patients with heart attack symptoms.

Once an SMI is diagnosed, your doctor can identify your main risk factors and help design a treatment strategy, including changing your diet, exercising regularly, and taking a statin as well as other medication to help prevent a second heart attack .

"If you do notice any symptoms of a SMI, do not brush them aside, even if you do not think they are serious," says Dr. Plutzky. "Playing it safe is always a better move than risking the potential harmful downside."

SMI warning signs

SMI symptoms are often mild and brief. Seek immediate medical attention if you experience one or more of the following:

Discomfort in the center of the chest that lasts several minutes, or goes away and comes back. It can feel like an uncomfortable pressure, squeezing, or pain.
Discomfort in other upper-body areas, such as one or both arms, the back, the neck, the jaw, or the stomach.
Shortness of breath before or during chest discomfort.
Breaking out in a cold sweat, or feeling nauseated or lightheaded.

Overview

A heart attack occurs when the flow of blood to the heart is severely reduced or blocked. The blockage is usually due to a buildup of fat, cholesterol and other substances in the heart (coronary) arteries. The fatty, cholesterol-containing deposits are called plaques. The process of plaque buildup is called atherosclerosis.

Sometimes, a plaque can rupture and form a clot that blocks blood flow. A lack of blood flow can damage or destroy part of the heart muscle.

A heart attack is also called a myocardial infarction.

Prompt treatment is needed for a heart attack to prevent death. Call 911 or emergency medical help if you think you might be having a heart attack.

Symptoms

Symptoms of a heart attack vary. Some people have mild symptoms. Others have severe symptoms. Some people have no symptoms.

Common heart attack symptoms include:

Chest pain that may feel like pressure, tightness, pain, squeezing or aching
Pain or discomfort that spreads to the shoulder, arm, back, neck, jaw, teeth or sometimes the upper belly
Cold sweat
Fatigue
Heartburn or indigestion
Lightheadedness or sudden dizziness
Nausea
Shortness of breath

Women may have atypical symptoms such as brief or sharp pain felt in the neck, arm or back. Sometimes, the first symptom sign of a heart attack is sudden cardiac arrest.

Some heart attacks strike suddenly. But many people have warning signs and symptoms hours, days or weeks in advance. Chest pain or pressure (angina) that keeps happening and doesn't go away with rest may be an early warning sign. Angina is caused by a temporary decrease in blood flow to the heart.

When to see a doctor

Get help right away if you think you're having a heart attack. Take these steps:

Call for emergency medical help. If you think you're having a heart attack, immediately call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only if there are no other options.
Take nitroglycerin, if prescribed to you by a health care provider. Take it as instructed while awaiting emergency help.
Take aspirin, if recommended. Taking aspirin during a heart attack may reduce heart damage by preventing blood clotting.
Aspirin can interact with other drugs. Don't take an aspirin unless your care provider or emergency medical personnel say to do so. Don't delay calling 911 to take an aspirin. Call for emergency help first.

What to do if you see someone who might be having a heart attack

If someone is unconscious and you think they're having a heart attack, first call 911 or your local emergency number. Then check if the person is breathing and has a pulse. If the person isn't breathing or you don't find a pulse, only then should you begin CPR.

If you're untrained in CPR, do hands-only CPR. That means push hard and fast on the person's chest — about 100 to 120 compressions a minute.
If you're trained in CPR and confident in your ability, start with 30 chest compressions before giving two rescue breaths.

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Causes

Coronary artery disease causes most heart attacks. In coronary artery disease, one or more of the heart (coronary) arteries are blocked. This is usually due to cholesterol-containing deposits called plaques. Plaques can narrow the arteries, reducing blood flow to the heart.

If a plaque breaks open, it can cause a blood clot in the heart.

A heart attack may be caused by a complete or partial blockage of a heart (coronary) artery. One way to classify heart attacks is whether an electrocardiogram (ECG or EKG) shows some specific changes (ST elevation) that require emergency invasive treatment. Your health care provider may use ECG results to describe these types of heart attacks.

An acute complete blockage of a medium or large heart artery usually means you've had an ST elevation myocardial infarction (STEMI).
A partial blockage often means you've had a non-ST elevation myocardial infarction (NSTEMI). However, some people with NSTEMI have a total blockage.

Not all heart attacks are caused by blocked arteries. Other causes include:

Coronary artery spasm. This is a severe squeezing of a blood vessel that's not blocked. The artery generally has cholesterol plaques or there is early hardening of the vessel due to smoking or other risk factors. Other names for coronary artery spasms are Prinzmetal's angina, vasospastic angina or variant angina.
Certain infections. COVID-19 and other viral infections may cause damage to the heart muscle.
Spontaneous coronary artery dissection (SCAD). This life-threatening condition is caused by a tear inside a heart artery.

Risk factors

Heart attack risk factors include:

Age. Men age 45 and older and women age 55 and older are more likely to have a heart attack than are younger men and women.
Tobacco use. This includes smoking and long-term exposure to secondhand smoke. If you smoke, quit.
High blood pressure. Over time, high blood pressure can damage arteries that lead to the heart. High blood pressure that occurs with other conditions, such as obesity, high cholesterol or diabetes, increases the risk even more.
High cholesterol or triglycerides. A high level of low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol) is most likely to narrow arteries. A high level of certain blood fats called triglycerides also increases heart attack risk. Your heart attack risk may drop if levels of high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — are in the standard range.
Obesity. Obesity is linked with high blood pressure, diabetes, high levels of triglycerides and bad cholesterol, and low levels of good cholesterol.
Diabetes. Blood sugar rises when the body doesn't make a hormone called insulin or can't use it correctly. High blood sugar increases the risk of a heart attack.
Metabolic syndrome. This is a combination of at least three of the following things: enlarged waist (central obesity), high blood pressure, low good cholesterol, high triglycerides and high blood sugar. Having metabolic syndrome makes you twice as likely to develop heart disease than if you don't have it.
Family history of heart attacks. If a brother, sister, parent or grandparent had an early heart attack (by age 55 for males and by age 65 for females), you might be at increased risk.
Not enough exercise. A lack of physical activity (sedentary lifestyle) is linked to a higher risk of heart attacks. Regular exercise improves heart health.
Unhealthy diet. A diet high in sugars, animal fats, processed foods, trans fats and salt increases the risk of heart attacks. Eat plenty of fruits, vegetables, fiber and healthy oils.
Stress. Emotional stress, such as extreme anger, may increase the risk of a heart attack.
Illegal drug use. Cocaine and amphetamines are stimulants. They can trigger a coronary artery spasm that can cause a heart attack.
A history of preeclampsia. This condition causes high blood pressure during pregnancy. It increases the lifetime risk of heart disease.
An autoimmune condition. Having a condition such as rheumatoid arthritis or lupus can increase the risk of a heart attack.

Complications

Heart attack complications are often due to heart muscle damage. Potential complications of a heart attack include:

Irregular or atypical heart rhythms (arrhythmias). Heart attack damage can affect how electrical signals move through the heart, causing heartbeat changes. Some may be serious and can be deadly.
Cardiogenic shock. This rare condition occurs when the heart is suddenly and abruptly unable to pump blood.
Heart failure. A lot of damage to the heart muscle tissue can make the heart unable to pump blood. Heart failure can be temporary or long-lasting (chronic).
Inflammation of the saclike tissue surrounding the heart (pericarditis). Sometimes a heart attack triggers a faulty immune system response. This condition may be called Dressler syndrome, postmyocardial infarction syndrome or postcardiac injury syndrome.
Cardiac arrest. Without warning, the heart stops. A sudden change in the heart's signaling causes sudden cardiac arrest. A heart attack increases the risk of this life-threatening condition. It can lead to death (sudden cardiac death) without immediate treatment.

Prevention

It's never too late to take steps to prevent a heart attack — even if you've already had one. Here are ways to prevent a heart attack.

Follow a healthy lifestyle. Don't smoke. Maintain a healthy weight with a heart-healthy diet. Get regular exercise and manage stress.
Manage other health conditions. Certain conditions, such as high blood pressure and diabetes, can increase the risk of heart attacks. Ask your health care provider how often you need checkups.
Take medications as directed. Your health care provider may prescribe drugs to protect and improve your heart health.

It's also a good idea to learn CPR properly so you can help someone who's having a heart attack. Consider taking an accredited first-aid training course, including CPR and how to use an automated external defibrillator (AED).

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In my own words: Heart health for myself and my family
Sandra Driggers is a nurse at Mayo Clinic in Florida who works in the Division of Cardiovascular Medicine. This is her heart health story. I struggled with my weight for most of my life. I never really gave a lot of thought to being healthy (or unhealthy), or about how my weight and lifestyle played a role in my future health.But a little over 16 years ago, I had a heart attack. Back then, at…

What are the 4 signs of an impending heart attack?

What are the symptoms of heart attack?.

Chest pain or discomfort. ... .

Feeling weak, light-headed, or faint. ... .

Pain or discomfort in the jaw, neck, or back..

Pain or discomfort in one or both arms or shoulders..

Shortness of breath..

How do you know if you've had a silent heart attack?

Imaging tests, such as an electrocardiogram or echocardiogram, are the only way to identify a silent heart attack. If you think that you've had a silent heart attack, talk to your health care provider. A review of your symptoms and health history and a physical exam can help your provider decide if you need more tests.

How can you rule out a heart attack at home?

Signs of a heart attack include: - Pain or discomfort in one or both arms, the back, neck, jaw or stomach. - Shortness of breath with or without chest discomfort. - Other signs such as breaking out in a cold sweat, nausea or lightheadedness. (If you're experiencing any of these symptoms, call 9-1-1 immediately.)