Heart Health

The Silent Heart Danger

Angina – pain in the chest, shoulders, arms, neck or jaw – is linked to heart attacks. But angin also has a “silent cousin” that can be just as dangerous although there are no symptoms.

In the May edition of the Harvard Health Letter, Harvard Medical School experts explore the condition called “silent ischemia.”

“People with heart disease may have five to 10 times as many episodes of silent ischemia as symptomatic ischemia,” says Dr. Peter Stone, a professor of medicine at Harvard Medical School and director of the vascular profiling research group at Brigham and Women’s Hospital.

According to the Health Letter, Ischemia comes from a Latin term that means “stopping blood.” It occurs when something, usually a coronary artery narrowed by cholesterol-laden plaque, fails to deliver enough oxygen-rich blood to the part of the heart muscle when the heart needs to work harder. This can happen during exercise, stress, or at any other time when the heart works harder than usual.

Painful or not, ischemia raises the risk of heart attack, especially in people who have high blood pressure or other factors that stress the heart. The Harvard experts list the factors that can lead to silent ischemia or angina:

walking outside briskly on a cold, windy, or humid day

hurrying with a heavy load

exerting yourself after a heavy meal

working under a deadline

speaking in public

engaging in sexual activity

being worried, tense, or angry.

Adding to the problem is the fact that detecting silent ischemia can be a challenge, according to the Health Letter. It is often discovered during a stress test to check for possible heart disease.

Several types of medication are used to treat ischemia. These include beta blockers, which lower the heart’s workload; calcium-channel blockers and nitrates, which improve blood flow by widening coronary arteries; and ranolazine (Ranexa), which also improves blood flow to the heart muscle.

The Harvard Heart Letter is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $20 per year. Subscribe at or by calling 877-649-9457 (toll-free).