Diabetes: Don’t Go Breaking My Heart!

Symptoms may not be present or delayed for diabetics.


Heart attacks in diabetics may not present with straightforward symptoms as some may suffer from diabetic neuropathy (nerve damage), leading to the masking of pain in the chest and other parts that it usually radiates to. This is called a silent heart attack. A silent heart attack is a heart attack that does not have the usual symptoms of chest pain or breathlessness. It has been estimated that approximately 4 million Americans have had silent heart attacks, and having diabetes raises the risk of having one.

A heart attack or myocardial infarction can occur when there is insufficient blood flow in the blood vessels supplying the heart (coronary arteries), causing a deficient supply of oxygen. This leads to damaged tissue and eventually death in the heart. It can also be caused by a clot (atherosclerosis – narrowing or blockage of the arteries due to fatty deposits).

The risk factors for heart attacks includes older age, male gender, high blood pressure, high cholesterol, positive family history of heart attack, smoking status, and diabetes. The usual heart attack patient may present with symptoms such as chest pain (typically crushing), radiation to one of the upper limbs (usually left), radiation of pain to the neck or jaw, cold sweats, breathlessness, nausea or vomiting, and anxiety.

Besides that, recent research has also found that diabetics are more likely to have delayed symptoms in ST-segment elevation myocardial infarction (STEMI), a subtype of a heart attack. Researchers in California reported a longer time for patients to present with symptoms in diabetics compared to non-diabetics. On average, diabetics with STEMI experience symptoms 50 minutes later compared to non-diabetics.

With the addition of every unit in the patient’s HbA1c, the time to symptoms presenting also increased accordingly. The duration of hospital stay is also extended in patients with diabetes. With this information, it is important for diabetics to realize that heart attack may not present in the typical ways for them. They should be more aware of their health condition, and it is best to see a doctor when there is chest pain.


Silent heart attack. Diabetes Self-Management. Accessed 3/23/2017.

STEMI symptom presentation delayed in diabetes. Endocrinology Advisor. Accessed 3/23/2017.