Noninvasive tests may help identify who’s really at risk for a heart attack.
About 25 years ago, when I was co-director of the Noninvasive Cardiology Laboratory at Mount Sinai Medical Center in Miami Beach, performing heart ultrasounds and exercise stress tests, I got a call from an internist who told me that one of his patients had just suffered a heart attack. He was puzzled because this patient had recently passed an exercise stress test…administered by me! I was very upset by this news and rechecked the test results to see if I had made any mistakes.
After careful review, I couldn’t find any errors in my analysis. The stress test was normal, and the patient had shown excellent exercise capacity. I remember feeling very frustrated. We were working with the best technology available, yet it wasn’t good enough to detect a heart attack that was only weeks away.
Today, we do have other noninvasive tests that are much better at predicting the likelihood of a future heart attack. A normal stress test does not mean there aren’t any potentially lethal soft plaques growing inside the lining of your coronary arteries that could rupture and cause a heart attack at any time. All it means is that the blood flow to your heart was fine on the day you took the test. Unfortunately, that doesn’t mean that the blood flow will still be fine tomorrow.
Recently, I was at a dinner party when another guest, upon hearing that I was a cardiologist, turned to me and said, “My friend just passed his annual physical with f lying colors. Two days later, he had a heart attack. How could this happen?” I’m sorry to say that I hear stories like this almost as often today as I did 25 years ago. The fact is, back then, we had an excuse. We didn’t know any better. Today, we do. We know that someone can look great on paper — pass a standard exercise stress test with f lying colors, have good cholesterol scores, and never have had a sick day in his or her life — but still have arteries that are a diseased and potentially lethal mess. Today we have access to cutting-edge diagnostic tests that can identify these high-risk people early enough to prevent them from having heart attacks in the first place.
The problem is that many patients destined for heart problems don’t get the benefit of our most accurate tests (including presidents of the United States). Many seemingly perfectly healthy people are “suddenly” getting heart attacks because their arteries are not perfectly healthy and they don’t know it. With the proper noninvasive tests, these diseased arteries would have been identified, and the heart attacks wouldn’t have happened.
Learn more in the Everyday Health Heart Health Center.