The hidden risks and silent symptoms of heart attacks
August 15, 2025Categories: Blog Posts
Tags: Cardiology
Heart attacks do not discriminate. While obesity is certainly a major risk factor for cardiovascular disease, even the most physically fit aren’t immune. From The Biggest Loser trainer Bob Harper, who experienced a near-fatal heart attack in 2017 during one of his routine workouts, to longtime wrestling legend Hulk Hogan, whose cause of death in July 2025 was ruled as acute myocardial infarction, these individuals are proof that those in peak physical condition can be at risk.
That’s because obesity isn’t the only risk factor. According to James Kilcoyne, DO, a Trinity Health Mid-Atlantic Medical Group cardiologist at Cardiology Langhorne, patients who appear to be the picture of health may be suffering from hidden threats—like high blood pressure and cholesterol, stress and genetic conditions—that can all contribute to a heart attack.
“One of the biggest, most concerning things is high blood pressure. Untreated high blood pressure can absolutely lead to heart attacks, strokes, all of that. Even a very in-shape person can have high blood pressure that isn’t treated,” says Dr. Kilcoyne.
Genetics sometimes play a massive part in heart health. For example, after his heart attack, Harper discovered that he has a hereditary condition called familial hypercholesterolemia, which causes high levels of LDL cholesterol and makes individuals more susceptible to heart attacks (he was 52). As for Hogan, he had a history of atrial fibrillation, which causes an irregular heartbeat. While certain underlying health conditions, lifestyle factors and age (Hogan was 71) can contribute to an AFib diagnosis, genetics are also known to play a role.
In younger, seemingly healthy folks, skyrocketing stress levels are a common risk factor for cardiovascular disease.
“One of the biggest, most concerning things is high blood pressure. Untreated high blood pressure can absolutely lead to heart attacks, strokes, all of that. Even a very in-shape person can have high blood pressure that isn’t treated.” – James Kilcoyne, DO
“I had a young guy in his 40s that just had his first heart attack. He’s otherwise a very active guy. His thing is stress,” says Dr. Kilcoyne. “It’s definitely something people bring up a lot. Life stress can cause all sorts of problems. Stress is chronic high cortisol and then that inflammation leads to plaque progression.”
Lesser-known symptoms of a heart attack
In addition to these hidden threats, there are numerous silent symptoms that indicate a heart attack could be on its way. While some patients do experience the common symptom of chest pain that radiates into the arm and/or jaw, others experience more subtle ones, including leg cramps while walking, and fatigue and shortness of breath during exercises or activities that used to be easy.
“That’s the one I think most people sort of dismiss, saying, ‘Well, I’m out of shape or maybe I’ve gained weight’,” says Dr. Kilcoyne. “They don’t think there’s a problem. I often see this in younger people.”
If a patient is exhibiting any of these symptoms, the Cardiology Langhorne team will complete lab work, an echocardiogram and stress test to make an accurate diagnosis. Is the shortness of breath caused by heart trouble, or something else like anemia, lung disease or an out-of-control thyroid? Once there is a clear answer, a plan of action is formed.
Even if an individual has no symptoms, annual visits with a primary care provider are vital to ensure there are no silent risk factors, like high blood pressure, that could eventually lead to a heart attack. The lab work done by PCPs can also help reduce a patient’s risk of heart attack, as it screens for things like anemia, high cholesterol and kidney function—all of which can impact plaque progression. In addition to yearly primary care visits, Dr. Kilcoyne recommends maintaining a reasonable diet and staying active.
Don’t delay getting help
According to Dr. Kilcoyne, it’s better to be safe than sorry when it comes to heart attacks. Though symptoms may be mild, like feeling fatigued and short of breath after walking a distance that used to be a breeze, there’s no such thing as being overly cautious. Rather than chalking it up to a slight weight gain or simply getting older, get checked by a PCP or cardiologist to make sure it’s not something more serious.
“I often try to tell people to trust their gut. If you feel like something’s wrong, you should get checked. If you’re feeling symptoms, if you think it’s not right, if you think it’s not normal, it probably isn’t normal. Don’t ignore your body. Inactivity, weight-related illness, diabetes, blood pressure, smoking, family history—all of these things don’t show themselves, but they’re definitely at work all the time causing plaque,” says Dr. Kilcoyne. “If you get seen early, and we find a blockage and can treat you, you’re much better off than if you come in one or two years later with a heart attack. That’s a much different situation. It’s never bad to get checked, even if you’re 20, 30, 40. I see everybody and it’s never a wasted visit, in my mind.”
“If you get seen early, and we find a blockage and can treat you, you’re much better off than if you come in one or two years later with a heart attack. That’s a much different situation.” – Dr. Kilcoyne
Currently, St. Mary Medical Center and Nazareth Hospital are positioning themselves to be at the forefront of heart care with the newly-formed Trinity Health Mid-Atlantic Medical Group Cardiology—an expanded practice comprised of experienced medical and interventional cardiologists from both facilities. With a growing fellowship program and state-of-the-art technology, like the brand-new cardiac MRI, the Bucks County and Philadelphia communities can expect top cardiology treatment.
“We’re always advancing and we’re always pushing our limits in medicine and trying to get the most up-to-date stuff for our patients,” says Dr. Kilcoyne.