All things considered, most of us would prefer not to become acutely ill in a public place. You’d rather not faint at Macy’s, upchuck in a theatre lobby, or suddenly become aware of the Mount St. Helen’s rumbling in your intestines as you sit third row center at Orchestra Hall. If you trip and fall on a busy sidewalk and a dozen helpful people ask if you’re hurt, your response is almost reflexively, “No, I’m all right, really,” as you bravely hobble into the anonymous crowd on a broken ankle.
Becoming seriously ill while exercising at a health club or outside running probably occurs a lot more often than we realize, but because of the wee competitive undercurrent lurking in the sweat-drenched air, you keep your chest pain or your shortness of breath to yourself. As a health club habitue for many years (what, you didn’t notice?), I’ve certainly seen fellow exercisers abruptly leave looking sweaty and ashen. Even if they were having heart attacks, to avoid the embarrassment of appearing vulnerable I’m guessing many would keep the pain to themselves. I’ve asked a couple of fitness trainers about this, and both told of multiple instances where an ambulance had to be called by staff because a client had collapsed, but never an example of a client requesting an ambulance.
If you work out regularly, you’ve probably thought at least once about this. When you join a health club, there’s always that recommendation advising the couch potatoes and over-40s to have an EKG and be cleared by a doctor before starting an exercise program. That’s actually pretty good advice if you’re out of shape, overweight, have high cholesterol, high blood pressure, or diabetes, or you’re a smoker.
The problem is that a routine physician clearance doesn’t yield much in the way of useful information for higher-risk health club members. You’ll have your blood pressure checked, heart and lungs listened to, maybe a cholesterol test, maybe an EKG, and then you’re sent off to the sweaty trenches with an approving pat on the head. The reason the EKG isn’t helpful is that it’s taken when you’re resting on a table, which is exactly what you won’t be doing at your health club.
Evaluating blood flow to your heart…ahead of time
By far the better screening device, which insurance companies cover (though they don’t like to because of cost), is a nuclear stress test.The original heart stress test dates from 1950 and was called the Master’s Two-Step Exercise Test. You climbed up and down two steps a certain number of times and then quickly had an EKG, which looked for exercise-induced changes, a sign of possible heart disease. Later, the steps were replaced by a treadmill.
Compellingly, however, a stress test alone misses about 50% of potentially dangerous heart blockages.
Enter the nuclear stress test:
- First, a tiny amount of harmless radioactive thallium is injected into a small IV line, carried by your bloodstream to your heart.
- After the injection you lie on a table beneath a scanner (which looks like an x-ray machine) as it records a picture of your heart at rest.
- Next you get on a treadmill, a technician attaches EKG leads to your chest, and off you go, walking for about ten minutes. As the angle of the treadmill increases, you’ll find yourself huffing, puffing, and sweating as you watch your heartbeat on the screen in front of you. Your goal is to reach 80% of the maximum heart rate for your age. (If you can’t manage this–due to a bad knee, for example–the cardiologist will inject a medicine that raises your heart rate to that vital 80% of max.)
- Once you’re off the treadmill, panting and all sweaty, heart a-pounding, you return to the scanner, which makes a post-exercise picture of your heart.
The cardiologist can now see your heart pumping and ensure that its walls and chambers are normal. Your doc is also looking for defects, areas in your heart reflecting inadequate blood flow. These are the trouble spots. Defects can indicate areas of blockage inside the coronary arteries. A complete blockage translates to a heart attack.
If there are significant defects on your scan, the cardiologist may recommend a coronary angiogram, an x ray procedure in which dye is injected into your coronary arteries to visualize the actual blockages. Angiograms are done in a hospital cardiac lab. If there are one or two significant blockages in an accessible part of the artery, the cardiologist may be able to insert a small expandable tube called a stent (here’s a nice rendering), which squeezes the blockage against the artery wall and opens the artery channel. If this isn’t possible, the recommendation may be to call in a cardiac surgeon to perform a coronary bypass graft procedure.
If all of this sounds grim, don’t worry. It certainly beats falling over dead at your health club.
In basically healthy people, nuclear scans are usually negative and you go home feeling good about yourself. Also, by the way, being able to do the full ten minutes of the stress test without symptoms is now listed as an “independent longevity factor.” Just like it sounds, this means you’ve got a better chance of living longer than someone who hops off early gasping, “Can’t…do…this.”
If you’re a WholeHealth Chicago patient at risk for heart disease, call the Lincoln Park Heart Center, 2266 N Lincoln Ave (three blocks south of WHC), and let them know you’re our patient. You’ll work either with Sukhjit S Gill, MD, or his son, Sanjay S Gill, MD. Both are board-certified cardiologists with special training in nuclear medicine. PPO insurance (Medicare as well) virtually always covers this procedure if you’re over 40, but remember in these days of high deductibles that you’ll probably reach your deductible with this test alone. HMO members need to get a referral from their primary provider.
If you’re not a WholeHealth Chicago patient, ask your primary physician to refer you to a local cardiologist or hospital specifically for a nuclear stress test.
As always, the best strategy is prevention. You can generally avoid angiograms, stents, bypass grafts, and statins by keeping your weight under control, exercising, eating well, and meditating.
David Edelberg, MD