Pass­ing the stress test but not the heart imag­ing test

Great Health Guide - - CONTENTS - Dr War­rick Bishop

You may sur­prise that fit­ness is no guar­an­tee of heart health and that the ar­ter­ies in your heart are in good shape. For in­stance, in re­cent years, I had an ex­tremely fit pa­tient come to see me for a stress test. At that time, he was train­ing for an en­durance event and by all ac­counts, he was in fan­tas­tic shape. Sev­eral years ear­lier we had scanned his heart and we found that he had a buildup of choles­terol in his ar­ter­ies for which he was al­ready re­ceiv­ing ther­apy. He had been train­ing hard for the en­durance event and he con­fided that he felt ready for the chal­lenge.


The rea­son for the tim­ing of the stress test is that he rou­tinely wore a heart rate mon­i­tor and he no­ticed that he was ex­pe­ri­enc­ing breath­less­ness when his heart rate ap­proached 150 to 160 beats per minute. Nev­er­the­less, when he un­der­took the stress test, he ap­peared as though he could keep run­ning all day and that is ex­actly what he had been train­ing to do.

As the tread­mill pro­gres­sively got faster, his heart rate in­creased and when he even­tu­ally hit 160 beats per minute, he was no­tice­ably gasp­ing for air. How­ever, he did not ex­pe­ri­ence chest pain and com­pared with many other pa­tients, he seemed be do­ing ex­cep­tion­ally well.


How­ever, other data that we col­lected from him was telling a com­pletely dif­fer­ent story. His ECG in­di­cated that

This very fit-look­ing man, train­ing for an en­durance event, had a sig­nif­i­cant nar­row­ing in the artery that sup­plies blood to the heart.

there was a re­duced blood flow to his heart as soon as he went over 140 beats per minute and this got grad­u­ally worse. I then took him off the tread­mill and put him on a bed so that we could ul­tra­sound his heart to see what was hap­pen­ing. The images clearly in­di­cated that the pos­te­rior part of his heart was not con­tract­ing prop­erly. This test was telling us that this very fit-look­ing man who had been train­ing for an en­durance event, had a sig­nif­i­cant nar­row­ing in the artery that sup­plies blood to the pos­te­rior wall of his heart. Within days he had an an­giogram to con­firm the di­ag­no­sis and ar­range­ments were made so that he could have an­gio­plasty which opens blocked ar­ter­ies and re­stores nor­mal blood flow to the heart. As sus­pected, the re­sults in­di­cated a nar­row­ing of the artery and he re­ceived a stent im­plant. Thus, his fit­ness was no guar­an­tee of heart health. Now, he is in

good health and has re­sumed his full train­ing regime.


It was very lucky that this man de­cided to get checked be­fore he par­tic­i­pated in the en­durance event, be­cause we can only sur­mise what would have hap­pened other­wise. What if he had been fooled by his ex­er­cise ca­pac­ity and his level of fit­ness? What if halfway through his en­durance event his nar­rowed artery had be­come a blocked artery? Well, I don’t have the power of div­ina­tion, but I do know that we can avert this type of risk through heart imag­ing, rather than sim­ply re­ly­ing on the health of the in­di­vid­ual.

Heart imag­ing is not for every­one, but it is cer­tainly a test that every­one should dis­cuss with their doc­tor to find out if it is ap­pro­pri­ate for them. Fit­ness is no guar­an­tee of heart health. Good health!

Dr War­rick Bishop is a car­di­ol­o­gist with spe­cial in­ter­est in car­dio­vas­cu­lar dis­ease pre­ven­tion in­cor­po­rat­ing imag­ing, lipids and life­style. He is au­thor of the book ‘Have You Planned Your Heart At­tack?’, writ­ten for pa­tients and doc­tors about how to live in­ten­tion­ally to re­duce car­dio­vas­cu­lar risk and save lives! Dr Bishop can be con­tacted via his

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