The Heartbeat You Didn’t Hear: Myanmar’s Silent Warning Signs of Heart Disease

By Dr Aung Tun

Every year on 29 Septem­ber, World Heart Day re­minds us that cardiovas­cular disease (CVD) remains the world’s leading cause of death. In 2026, the World Heart Federation continues its “Don’t Miss a Beat” campaign with a sharper focus on recognizing signs and symp­toms that can be overlooked. Its call is simple and practical: see the signs, protect your heart and demand action.

That message is especially relevant because heart disease does not always look the way peo­ple expect. Some cardiovascular conditions, particularly high blood pressure, can develop silently. At the same time, warning symp­toms of a heart attack, stroke, heart failure or abnormal heart rhythm may be dismissed as in­digestion, tiredness, anxiety or simply ageing. The challenge, therefore, is not only to prevent CVD, but also to recognise when the heart and circulation may al­ready be in trouble.

When Silence Kills

Cardiovascular disease is re­sponsible for an estimated 19.8 million deaths worldwide each year, according to the World Health Organization’s 2025 up­date, accounting for about 32 per cent of all global deaths in 2022. Heart attacks and strokes together caused about 85 per cent of those deaths. More than three-quarters of CVD deaths occur in low- and middle-income countries.

The word “silent” needs to be used carefully. High blood pres­sure, for example, often causes no symptoms. Other cardiovascular emergencies may produce warn­ing symptoms, but people may not recognise their significance. Chest pressure may be blamed on indigestion. Unusual breath­lessness may be attributed to age or heat. Palpitations may be dis­missed as stress or too much tea. The danger lies both in truly silent risk factors and in symptoms that are present but misunderstood.

Myanmar’s Cardiovascular Challenge

Myanmar faces a substantial burden from stroke, ischaemic heart disease and other noncom­municable diseases. The pattern underlines the importance of rec­ognizing both stroke and heart-at­tack symptoms quickly, while also finding and controlling silent risk factors such as hypertension.

For stroke, the internation­ally recognised FAST message remains useful: Face drooping, Arm weakness, Speech difficul­ty and Time to seek emergency medical help. Sudden weakness or numbness on one side, sud­den difficulty speaking or under­standing speech, sudden visual disturbance, severe unexplained headache, loss of balance or sud­den confusion should never be ignored. Stroke is time- sensitive; earlier assessment can improve the opportunity for effective treat­ment and reduce disability.

The Symptoms Too Often Overlooked

Heart attack symptoms. Chest pressure, squeezing, heav­iness or discomfort remains an important warning sign, but not every heart attack presents dra­matically. Symptoms can also include pain or discomfort in the arm, shoulder, back, neck or jaw; shortness of breath; nausea; light-headedness; or cold sweat­ing. Women, older adults and peo­ple with diabetes may sometimes have less typical presentations, making awareness particularly important.

Silent hypertension. High blood pressure usually has no obvious symptoms, yet over time it can damage blood vessels and increase the risk of stroke, heart attack, heart failure and kidney disease. Historical research in four Myanmar townships report­ed a high prevalence of hyper­tension among adults over 40, but that study should not be in­terpreted as a national estimate. More importantly, the nationally representative Myanmar STEPS Survey 2024 found hypertension in 24.4 per cent of adults aged 18-69 years - nearly one in four - demon­strating why routine blood-pres­sure measurement matters even when a person feels well.

Irregular heartbeat. A flutter­ing, racing or irregular heartbeat may be harmless in some situa­tions, but persistent or recurrent palpitations - particularly when accompanied by fainting, chest discomfort, marked breathless­ness or dizziness - deserve med­ical assessment. Some abnormal heart rhythms, including atrial fibrillation, can increase the risk of stroke.

Breathlessness and swelling. Increasing shortness of breath during ordinary activity, difficulty breathing when lying flat, unusual fatigue or swelling of the ankles can be warning features of heart failure or other cardiopulmonary conditions. These symptoms are not specific to heart disease, but persistent or worsening symp­toms should not simply be accept­ed as an inevitable part of ageing.

Who May Be Missed?

Warning signs can be over­looked at any age. Women may ex­perience symptoms that are less readily recognised as heart-relat­ed, and the World Heart Federa­tion’s 2026 campaign specifically highlights overlooked symptoms in women. Younger adults may also underestimate risk because cardiovascular disease is com­monly associated with older age. Congenital and inherited heart conditions can affect younger peo­ple, while tobacco use, high blood pressure, diabetes, obesity and physical inactivity can increase cardiovascular risk across adult­hood.

People living with hyperten­sion face a particular challenge because feeling well does not mean blood pressure is con­trolled. Stopping prescribed treat­ment simply because symptoms are absent can allow silent vas­cular damage to continue. Regu­lar measurement, adherence to prescribed treatment and peri­odic clinical review are therefore central to prevention.

From Awareness to Action: Don’t Miss a Beat 2026

The World Heart Federation’s 2026 message can be translated into three practical actions for Myanmar.

See the signs. Learn the warning signs of heart attack and stroke. Know that sudden one-sid­ed weakness or speech difficul­ty is an emergency. Recognise that persistent chest discomfort, unexplained severe breathless­ness, fainting or other concerning symptoms require prompt medi­cal assessment. At the same time, remember that hypertension may give no warning at all - it must be measured.

Protect your heart. Preven­tion still provides the greatest op­portunity. Avoid tobacco, reduce excess salt, eat a balanced diet rich in fruits and vegetables, re­main physically active, maintain a healthy weight, and have blood pressure, blood glucose and other cardiovascular risks checked as appropriate. Myanmar STEPS 2024 reported that 23.3 per cent of adults aged 18-69 currently smoked tobacco, reinforcing the continuing importance of tobacco control.

Demand action. Heart health cannot rest on indi­viduals alone. Communi­ties need accessible blood pressure screening, relia­ble referral pathways and health workers equipped to recognise cardiovascu­lar risk and urgent symp­toms. Public communica­tion should make stroke and heart-attack warning signs as familiar as mes­sages about diet, tobacco and exercise.

Strengthening the Front Line

Basic health staff and community-based health workers can play an im­portant role in prevention and early recognition, par­ticularly where specialist services are distant. In­tegrating simple cardio­vascular risk assessment, blood-pressure measure­ment, symptom recognition and referral guidance into existing NCD services can help identify people who need further care.

Health education should also distinguish between prevention and emergency recognition. A person can follow a healthy lifestyle and still need to know the signs of a stroke or heart attack. Conversely, waiting for symptoms is not a safe strategy for detecting hypertension, diabetes or high cholesterol. Both mes­sages belong together: pre­vent what can be prevent­ed, measure what can be silent, and act quickly when warning signs appear.

A National Promise to Listen

World Heart Day 2026 is an opportunity to lis­ten more carefully to the body’s signals without cre­ating unnecessary fear. Not every episode of tiredness, indigestion or palpitation is heart disease, but per­sistent, severe or sudden symptoms deserve appro­priate assessment. Sud­den chest discomfort with breathlessness or sweat­ing, or FAST symptoms of stroke, require urgent medical attention.

For Myanmar, where hypertension affects nearly one in four adults aged 18- 69 in the 2024 STEPS Sur­vey, the message is particu­larly clear: knowing your numbers and knowing the warning signs are two sides of the same prevention strategy. A blood-pressure check can uncover a silent risk; recognizing FAST can save precious time after a stroke begins.

“Don’t Miss a Beat” is more than a campaign slo­gan. It is a reminder to see the signs, protect the heart through everyday choices, and strengthen systems so that timely care is within reach. Every heartbeat matters - and awareness, prevention and prompt ac­tion can help more of those heartbeats continue.

REFERENCES

1. World Heart Federa­tion. World Heart Day 2026: Don’t Miss a Beat. 2026.

2. World Health Organi­zation. Cardiovascular Diseases (CVDs). Fact Sheet. Updated 31 July 2025.

3. Ministry of Health, Myanmar. Myanmar STEPS Survey 2024: National Survey of Non­communicable Disease Risk Factors. 2025/2026.

4. GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decompo­sition in 204 countries and territories and 811 subnational locations, 1990-2021. The Lancet. 2024.

5. Zaw KK, et al. Preva­lence of cardiovascular morbidities in Myan­mar. BMC Research Notes. 2017.