Silent Ischemia: What You Need to Know about this Symptomless Heart Condition

heart and stethoscope in vintage style

Ischemia is a temporary condition in which the heart doesn’t receive enough blood to do its job properly. When this happens you might feel chest pain known as angina. You might, however, feel no symptoms at all—this is known as silent ischemia.

The partial reduction in blood flow to the heart during ischemia is probably caused by a buildup of cholesterol (plaque) in the arteries. When your heart needs more blood to work harder, such as when you’re exercising or feeling emotional stress, the buildup makes it difficult for enough blood to reach the heart through the narrowed arteries.

If you’ve ever felt the discomfort of angina—and perhaps had pain spread to your shoulders, arms, neck, or jaw—you know that you’ve experience ischemia. It’s pretty common, however, for ischemia to occur “silently,” or without symptoms.

A Women’s Health Concern

Ischemic heart disease (also called coronary artery disease) is a significant women’s health concern. In fact, ischemic heart disease is the leading cause of death among women in the Western world, making awareness of ischemia very important among women.

How Do You Know if You’re Experiencing Silent Ischemia?

Even when you don’t feel any symptoms of ischemia, you may be able to know you’ve had an episode. While you might not have the typical signs of angina, or chest discomfort, or the shortness of breath and sweating that sometimes comes with it, your doctor, can give you tests to find out if you have heart disease and if you’ve experienced ischemia. Your risk is higher if you have a history of coronary or other vascular disease, diabetes, or chronic kidney disease.

Your doctor can use a test called an electrocardiogram (ECG) to measure your heart’s electrical activity. A certain pattern in the ECG can indicate if your heart doesn’t appear to be getting enough blood (even though you haven’t had symptoms). In this case, you may have experienced silent ischemia.

Why It’s Important to Detect and Treat Silent Ischemia

Even when ischemia doesn’t cause symptoms, it can mean you’re a higher risk for a heart attack. If you smoke or have high cholesterol or high blood pressure, your risk is greater. You can help lower your risk for heart attack by detecting and treating ischemia.

Drugs to treat ischemia are aimed at restoring normal blood flow to your heart. They include drugs to lower the heart’s workload (beta blockers), drugs to widen blood vessels (calcium-channel blockers and nitrates), and a drug that might increase blood flow to areas of the heart affected by ischemia (Reanexa® [ranoloazine]). People with severe ischemia might undergo a procedure to open the arteries (angioplasty) and get a stent (a small mesh tube that’s used to treat narrow or weak arteries).

You can reduce your risk of ischemia and help keep your heart healthy by practicing good heart-health habits. These include eating a sensible diet, getting regular exercise, maintaining a healthy weight, and keeping blood pressure and cholesterol at healthy levels (using medications, if needed).


Kusnoor AV, Ferguson AD, Falik R. Ischemic heart disease in women: a review for primary care physicians. Southern Medical Journal. 2011 Mar;104(3):200-4. doi: 10.1097/SMJ.0b013e31820bffd3.