My heart tests are normal- Am I immune from heart attack?

By Dr. Rajeev Rathi in Cardiac Sciences

Mar 02 , 2020 | 2 min read


A forty-five year old CEO of a start-up came to emergency room with sudden chest pain. He was having a heart attack.

When this was revealed to his wife, she was exasperated “How can this happen? Only ten days back he had complete heart check-up at another hospital and he was told everything was fine!”, you can see all these reports in my mobile.”

She was right, his basic check-up including a cardiac stress test were normal then. However, now his angiography showed 100% blockage in one of the main arteries of his heart, which required placing a stent to save heart and life.

The question arises: Does normal stress test for heart (TMT/Stress echo/ Stress Thallium) gives you immunity from heart attack?

The answer is NO!

So what is the utility of these tests?

The vessels which supply blood to the heart may have cholesterol deposits within their walls. This process is called atherosclerosis, and leads to narrowing of the vessels. Unless the vessel is narrowed more than 70%, it does not severely affect the functioning of heart. A regular heart check-up including a stress test would not pick up heart vessel narrowing if it is not severe enough to limit the blood supply to heart muscles. Even a stress test may remain normal. A heart attack, as opposed to angina, is due to a sudden, complete blockage of a blood vessel of the heart. This catastrophic phenomenon, unfortunately, can happen with any degree of narrowing over a period of few hours to result in heart attack. The resulting heart attack can also be a reason for cardiac arrest, This is due to the fat deposits in the vessel wall rupturing inside the vessel, suddenly clogging it up. While various tests may help us in stratifying the risk of heart disease, there is no way to accurately predict when these fat deposits may destabilize and rupture. Therefore, adequate lifestyle modification and adherence to advised medications is of utmost importance.

  • Diet – Should have more vegetables, fruits & avoid trans fat
  • Proper control of blood pressure & diabetes
  • No to tobacco (any form)
  • Regular physical exercise
  • Control over Cholesterol
  • Reduce stress

It is also of equally essential to identify the symptoms of heart attack at the earliest and seek timely medical assistance. The damage to the heart muscles increases drastically as time passes, and can soon become irreversible. Unfortunately, the symptoms can often be subtle or confusing, leading to a delay in seeking medical assistance.

With the near-ubiquitous penetration of smart phones in the general population, a mobile app can help disseminate information as well as preliminary assessment of suspicious symptoms.

While these can in no way replace a doctor’s assessment, they definitely can facilitate patients to seek early medical attention.