A cardiologist explains why you can have a normal stress test one day and then a massive heart attack the next.
You’ve probably heard of instances in which a person had a normal stress test but then next day dropped dead of a massive heart attack. How can this be?
“We have more and more theories about how plaque develops within the coronary arteries,” says Monica Reynolds, MD, a cardiologist with ColumbiaDoctors Medical Group in White Plains, NY.
“We are starting to understand how soft plaque can rupture and lead to greater plaque formation.
“Sometimes these ruptures are minor and result in minor or no symptoms, but other times the rupture can be catastrophic, resulting in a totally occluded artery where before there had only been minor non-obstructive plaque.
“This catastrophic rupture often explains how a patient can have a normal stress test one day and a massive heart attack the next.”
To make this easier to understand, imagine a tube. The inner wall of the tube is only lightly covered with patches of sludge.
Water flows freely through the tube; there is no narrowing or restriction of the water flow.
One day, a piece of the sludge dislodges from the inner wall and travels down the tube, getting stuck at some point—stuck in a way that it blocks the flow of water.
That’s how a heart attack occurs when soft plaque ruptures in a coronary artery that, according to a stress test, has no restricted blood flow.
What a Stress Test Looks For
A stress test measures perfusion: blood flow through the coronary arteries.
A stress test does not measure amount of soft plaque, and it’s the soft plaque that can rupture (hard or calcified plaque can’t).
To kick back any soft plaque you may have in your coronary arteries, avoid processed food as much as possible.
So if you want a chicken, rice and broccoli dinner, make it the way someone in the year 1902 would have made it, rather than buying a frozen dinner.
Though it’s nice to know that one’s stress test was normal, there’s always that small chance that a massive heart attack is around the corner.
This is why it’s so important to keep on top of your heart health even if you don’t seem to have any risk factors or suspicious symptoms.
Since 1992 Dr. Reynolds has practiced clinical cardiology at ColumbiaDoctors Medical Group, one of the largest multi-specialty practices in New York State.
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.
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