Heart to heart

It is shocking to hear about someone dropping dead of a heart attack when the person seemed healthy, athletic and with no obvious risk factors. How could it have happened?

During the past two months, I heard of three cases of “healthy” people who passed away in the middle of their sport activities. Just recently, a good friend of mine called me in the dead of night, unappeasably hysterical, because her husband dropped dead on the tennis court right in front of her eyes. He was in his early 50s, active and with an athletic built. One deterrent factor, which I could blame on his sudden demise, was his chain-smoking habit. In my mind, no matter how healthy he ate and how much he exercised, his smoking habit killed him.

There were two other recent cases of athletic men in their early 50s who died of a heart attack — one was in the middle of a squash game, while the other was in a swimming competition.

I asked my cardiologist in New York to recommend new heart tests that mature people should undergo. He gave me a link to go to for research purposes and these are my findings.

Heart experts say that it is important to do the new heart tests because the risk factors (smoking, family history, high cholesterol) will not tell you if your arteries have plaque and are not dilating properly.

Doctors recommend that patients undergo high-tech heart tests that offer detailed images of the blood vessels as a means of lowering heart disease risks. The three tests — calcium coronary scores, carotid artery ultrasound and CT heart scans (CT angiography) — “are all good at determining early atherosclerosis or hardening of the arteries,” explains American Heart Association (AHA) past president Dr. Robert Bonow, head of cardiology at Northwestern University’s Feinberg School of Medicine in Chicago.

• Coronary calcium scores

Calcium is one component of plaque that builds up inside the coronary arteries that supply oxygen-rich blood to the heart muscle. Measuring it can help determine the level of plaque buildup that leads to narrowing of the heart arteries, the hallmark of coronary artery disease.

During the test, you lie in a hollow CT scanner. X-ray beams create multiple images of the heart; a computer measures the amount and density of calcium deposits in the artery walls and provides a calcium score. The score can range from 0 to more than 400 and any score over 100 is associated with an increased risk of heart disease. One study published last year in the New England Journal of Medicine showed that the coronary calcium score predicted heart events — heart attack, death from coronary heart disease, or chest pain (angina) among men and women of all races. In that study, people with calcium scores of 101 to 300 were more than seven times as likely to experience a heart event than someone with no evidence of coronary calcium.

• Carotid artery ultrasound

This test uses ultrasound and sophisticated software to quantify the thickening of the inner walls of the carotid arteries that supply blood to the brain, a sign of early atherosclerosis.

This is a painless non-invasive test that can be performed easily in the doctor’s office and does not expose the patient to radiation.

One disadvantage though is “unlike coronary calcium scores, carotid artery ultrasound does not inform you directly about the heart, as you are looking at the arteries in the neck,” says Dr. Naghavi, chairman of the Society for Heart Attack Prevention and Eradication (SHAPE), and director of American Heart Technologies in Houston.

• CT heart scans

CT heart scan is also known as CT angiography. During the process, a patient receives a contrast dye through an IV (intravenous). X-rays are passed through the body and are picked up by detectors in the scanner. Special software uses the information gathered during the scan to create 3-D images of the coronary arteries on a computer screen.

CT angiography scans give doctors a detailed look at the coronary arteries, which supply blood to heart muscle without cardiac catheterization.

Who should get CT heart scans? “While calcium scores and carotid artery scans are used to evaluate people without symptoms, CT angiography is typically reserved for immediate-risk people with symptoms such as chest pain or shortness of breath that could be due to coronary heart disease,” says Dr. Todd Villiness, co-director of cardiac CT at Walter Reed Army Medical Center in Washington, DC.

The technique is quick, producing pictures within five to 10 seconds, compared with 30 to 45 minutes for cardiac catheterization, the “gold standard” for evaluating blood vessel constructions. It is non-invasive, with less risk and discomfort than catheterization, which often requires sedatives and sometimes a night in the hospital.

“The disadvantage of heart CT is it fails to produce good images in people with a lot of calcium and cannot be used in people with chronic kidney disease or severely obese patients,” Villines says. There are also cancer risks because CT angiography has the potential to expose patients to high doses of radiation, like an average CT exposure is equal to 600 x-rays!

In summary, these are the tests, which can be used to determine whether you are a candidate for a heart event. The results of these tests could influence the type of preventive treatments, which your doctors should recommend.

According to these heart experts, no test is perfect and regardless of test results, optimizing lifestyle choices still remains a cornerstone of heart disease prevention.