Can you have normal blood pressure and 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.

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.

What is blood pressure?

Blood pressure is the pressure of blood pushing against the walls of your arteries. Arteries carry blood from your heart to other parts of your body.

Your blood pressure normally rises and falls throughout the day.

What do blood pressure numbers mean?

Blood pressure is measured using two numbers:

The first number, called systolic blood pressure, measures the pressure in your arteries when your heart beats.

The second number, called diastolic blood pressure, measures the pressure in your arteries when your heart rests between beats.

If the measurement reads 120 systolic and 80 diastolic, you would say, “120 over 80,” or write, “120/80 mmHg.”

What are normal blood pressure numbers?

A normal blood pressure level is less than 120/80 mmHg.1

No matter your age, you can take steps each day to keep your blood pressure in a healthy range.

What is high blood pressure (hypertension)?

High blood pressure, also called hypertension, is blood pressure that is higher than normal. Your blood pressure changes throughout the day based on your activities. Having blood pressure measures consistently above normal may result in a diagnosis of high blood pressure (or hypertension).

The higher your blood pressure levels, the more risk you have for other health problems, such as heart disease, heart attack, and stroke.

Your health care team can diagnose high blood pressure and make treatment decisions by reviewing your systolic and diastolic blood pressure levels and comparing them to levels found in certain guidelines.

The guidelines used to diagnose high blood pressure may differ from health care professional to health care professional:

• Some health care professionals diagnose patients with high blood pressure if their blood pressure is consistently 140/90 mm Hg or higher.2 This limit is based on a guideline released in 2003, as seen in the table below.
• Other health care professionals diagnose patients with high blood pressure if their blood pressure is consistently 130/80 mm Hg or higher.1 This limit is based on a guideline released in 2017, as seen in the table below.

If you are diagnosed with high blood pressure, talk with your health care team about your blood pressure levels and how these levels affect your treatment plan.

What are the signs and symptoms of high blood pressure?

High blood pressure usually has no warning signs or symptoms, and many people do not know they have it. Measuring your blood pressure is the only way to know whether you have high blood pressure.

What causes high blood pressure?

High blood pressure usually develops over time. It can happen because of unhealthy lifestyle choices, such as not getting enough regular physical activity. Certain health conditions, such as diabetes and having obesity, can also increase the risk for developing high blood pressure. High blood pressure can also happen during pregnancy.

You can manage your blood pressure to lower your risk for serious health problems that may affect your heart, brain, kidneys, and eyes.

What problems does high blood pressure cause?

High blood pressure can damage your health in many ways. It can seriously hurt important organs like your heart, brain, kidneys, and eyes.

The good news is that, in most cases, you can manage your blood pressure to lower your risk for serious health problems.

Heart Attack and Heart Disease

High blood pressure can damage your arteries by making them less elastic, which decreases the flow of blood and oxygen to your heart and leads to heart disease. In addition, decreased blood flow to the heart can cause:

• Chest pain, also called angina.
• Heart attack, which happens when the blood supply to your heart is blocked and heart muscle begins to die without enough oxygen. The longer the blood flow is blocked, the greater the damage to the heart.
• Heart failure, a condition that means your heart can’t pump enough blood and oxygen to your other organs.

Stroke and Brain Problems

High blood pressure can cause the arteries that supply blood and oxygen to the brain to burst or be blocked, causing a stroke. Brain cells die during a stroke because they do not get enough oxygen. Stroke can cause serious disabilities in speech, movement, and other basic activities. A stroke can also kill you.

Having high blood pressure, especially in midlife, is linked to having poorer cognitive function and dementia later in life. Learn more about the link between high blood pressure and dementia from the National Institutes of Health’s Mind Your Risks®external icon campaign.

Kidney Disease

Adults with diabetes, high blood pressure, or both have a higher risk of developing chronic kidney disease than those without these conditions.

How do I know if I have high blood pressure?

There’s only one way to know if you have high blood pressure: Have a doctor or other health professional measure it. Measuring your blood pressure is quick and painless.

Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure (SMBP) monitoring.

High blood pressure is called the “silent killer” because it usually has no warning signs or symptoms, and many people do not know they have it.

What can I do to prevent or manage high blood pressure?

Many people with high blood pressure can lower their blood pressure into a healthy range or keep their numbers in a healthy range by making lifestyle changes. Talk with your health care team about

• Getting at least 150 minutes of physical activity each week (about 30 minutes a day, 5 days a week)
• Not smoking
• Eating a healthy diet, including limiting sodium (salt) and alcohol
• Keeping a healthy weight
• Managing stress

Learn more about ways to manage and prevent high blood pressure.

In addition to making positive lifestyle changes, some people with high blood pressure need to take medicine to manage their blood pressure. Learn more about medicines for high blood pressure.

Talk with your health care team right away if you think you have high blood pressure or if you’ve been told you have high blood pressure but do not have it under control.

By taking action to lower your blood pressure, you can help protect yourself against heart disease and stroke, also sometimes called cardiovascular disease (CVD).

Learn More

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