Exploring Women’s Silent Heart Attacks: Cardiologist Explains MINOCA and Heart Attacks Without Blocked Arteries

When most people think of a heart attack, they imagine a blocked artery causing sudden, severe symptoms. But for many women, especially those under 65, heart attacks don’t always follow this pattern. These women can experience heart attacks even when their arteries appear clear. This phenomenon is lesser known but equally dangerous.

Silent heart attacks in women often go unrecognised because their symptoms may be faint or mistaken for other conditions like stress or digestive issues. To know more about it, we reached out to Dr PRLN Prasad, Consultant – Interventional Cardiologist, Gleneagles BGS Hospital, Kengeri, Bengaluru, who shared that many women experience heart attacks even when angiograms show no major blockages.

What Are Heart Attacks Without Blocked Arteries?

Dr PRLN Prasad explains, “Heart attacks have long been linked to blocked coronary arteries, usually from cholesterol and fat buildup. But research now shows that a substantial number of women experience heart attacks without major obstruction.” This condition is called MINOCA, Myocardial Infarction with Non-Obstructive Coronary Arteries.

Dr Prasad further notes that studies, such as one study from the Mayo Clinic, find that over half of heart attacks in women under 65 are caused by factors other than blockages. These include spontaneous coronary artery dissection (SCAD), small embolisms, and stress-induced cardiomyopathy, also known as “broken heart syndrome.” Because these often don’t show on routine angiograms, diagnosis can be missed, delaying the right treatment.

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What Is MINOCA?

According to Dr Prasad, heart attacks have been tied to blocked coronary arteries from cholesterol-based plaques. But newer research shows that a significant share of heart attacks, especially in women, happen without any major obstruction. This is called Myocardial Infarction with Non-Obstructive Coronary Arteries, aka MINOCA. According to Dr Prasad:

MINOCA accounts for about 6% to 15% of all heart attacks. Women are far more likely than men to experience MINOCA. Some studies report women have up to five times the odds compared to men. 

Common mechanisms behind these silent heart attacks include:

• Tiny blood clots or embolisms that dissolve before detection
• Spasms in the coronary arteries (sudden narrowing without plaque)
• Microvascular dysfunction (issues in the small vessels supplying the heart muscle)
• Spontaneous coronary artery dissection (SCAD) or sudden tears in artery walls 
• Stress-induced conditions that weaken the heart muscle temporarily (such as “broken heart syndrome” / stress cardiomyopathy)

Because these causes don’t show up as blocked arteries in standard angiograms, they are often missed, which means patients may not receive the correct treatment on time.

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Symptoms Often Missed: What Women Should Watch For

Heart attacks in women, especially silent ones, may present differently than the dramatic chest-clutching scenes often shown in the media. Common subtle signs include:

• Shortness of breath or unexplained breathlessness
• Nausea, indigestion or vomiting
• Pain radiating to the back, neck, jaw, or stomach rather than the classic left-chest squeeze
• Lightheadedness, dizziness, or unusual weakness
• Extreme fatigue, even after normal activity
• Discomfort that comes and goes

Because these symptoms overlap with stress, hormonal changes, digestive issues or normal fatigue, many women ignore them. That’s dangerous. Early recognition and prompt medical evaluation matter.

Why Standard Tests May Not Be Enough?

Standard coronary angiograms check for clogged arteries, but they may miss the causes behind silent heart attacks. That’s why experts increasingly recommend additional imaging and functional tests when a woman has heart-attack-like symptoms but clear arteries. These may include:

• Coronary Optical Coherence Tomography (OCT) like a high-resolution imaging technique of the inner artery walls to detect subtle tears or plaque rupture. 
• Cardiac Magnetic Resonance Imaging (cardiac MRI) to spot damage in the heart muscle, inflammation, or other non-blockage causes. 
• Tests for microvascular dysfunction, blood-clotting abnormalities, or artery spasms, if clinical suspicion remains high even when initial scans are normal.

Prevention & Daily Heart Care: What Women Can Do

Even though silent heart attacks are harder to detect, many of the contributing factors are modifiable. As Dr Prasad emphasises, regular preventive care and healthy lifestyle habits are crucial. Here are some practical steps:

• Manage stress with mindfulness, meditation, or gentle exercises. Stress is a known trigger for non-obstructive heart problems.
• Stay active: moderate aerobic activity (walking, swimming, cycling) supports heart and blood vessel health.
• Eat balanced meals: plenty of fruits, vegetables, whole grains, lean protein, healthy fats — avoid excessive processed foods.
• Avoid smoking and limit alcohol; both can worsen vascular health and raise clotting risks.
• Get regular check-ups: especially if you have risk factors (family history, hypertension, diabetes, high stress), or have experienced unexplained chest pain or breathlessness.
• Pay attention to symptoms, even subtle ones and seek prompt medical advice, even if initial tests seem “normal.”

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Conclusion

Women’s heart health isn’t just about blood vessel blockages. Silent heart attacks are real and can be life-threatening. By recognising subtle signs, managing stress, maintaining healthy habits, and seeking prompt medical advice, women can protect their hearts and lives. Paying attention to small body changes can lead to early detection and better outcomes.