Yes, a person can have a normal stress test but a heart attack shortly after, says a cardiologist.
Ever wonder if you can have normal stress test results, then suffer a heart attack soon afterwards?
It can happen, says Dr. Sameer Sayeed, a cardiologist at ColumbiaDoctors of Somers, NY.
Plaque buildup in artery. Shutterstock/Explode
Dr. Sayeed explains, “A stress test can miss blockages that are less than 50% of coronary artery luminal diameter because they may not cause enough compromise in blood flow to be detected on a stress test.
“But it is these less severe blockages that tend to be more unstable and prone to rupture, causing a sudden heart attack when they do rupture, such as in the setting of vigorous exercise–snow shoveling.”
The reason these are more unstable is because when plaque buildup is less than 50 percent, it hasn’t been around long enough to harden.
Soft plaque is prone to breaking off in tiny fragments, and those fragments can obstruct a coronary artery, causing a heart attack by preventing blood flow to the portion of the heart that the affected artery feeds.
Strenuous exercise can cause the soft plaque to rupture in a person who’s not accustomed to strenuous activity such as shoveling snow.
This can explain why a seemingly “healthy” person literally drops from a heart attack while shoveling snow.
You may be thinking, Gee, if blockage under 50 percent can be so harmful, maybe I should eat up the cheeseburgers and fries to get that percentage up to like 80 percent.
But Dr. Sayeed points out, “No, what this means is that in some people, whether they have mild or severe blockages, if the plaque is soft, meaning it has not been around long enough to become calcified — natural response by the body — the soft plaques tend to be more susceptible to rupture or erosion compared to a hardened calcified plaque that is slightly more stable.”
To learn how much of your coronary arteries have calcified, get a coronary calcium score test.
“The higher percentage plaques tend to be more calcified because they have been around longer and have been increasing in severity over time, and have become calcified and remodeled and more stable over time if the person never had a plaque rupture and heart attack.
“This can occur in those with silent coronary artery disease where the plaques slowly develop, become calcified over years and the person is just lucky they never had an event.
“And they only develop symptoms once these calcified severe lesions block blood flow enough to cause symptoms such as chest pain.
“This is usually in someone who is pretty well-conditioned and healthy but had risk factors.”
This doesn’t mean that a very high coronary calcium score means you’re safe from a heart attack.
Dr. Sayeed adds that in general, smokers won’t last long enough for their coronary artery plaque buildup to reach a severely calcified state “because the cigarette smoke will cause a soft plaque to rupture.”
He also explains that “heart attacks can occur from other types of plaque pathology such as plaque erosion, not just rupture from a plaque that may not be detected on a stress test.”
What percentage of people, after being told their stress test was normal, have a heart attack soon after?
Dr. Sayeed says, “Hard to say what the percentage is, but probably around 5-10% depending on the sensitivity and specificity of the stress test that was performed.”
Dr. Sayeed performs echocardiograms and stress tests at the Midtown Manhattan and Westchester offices at Columbia Doctors. He is also trained in cardiac CT imaging.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Top image: Shutterstock/Andrey_Popov
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