How long to kill the heart (that pumpy thingy, not the lovey thingy)?

September 18, 2008 5:00 PM

How long to kill the heart (that pumpy thingy, not the lovey thingy)?

I had an echocardiogram (aka, stress test) earlier this year and it got me wondering: how long would it take to go from a perfectly healthy heart to one in grave danger? Not counting, say, infectious diseases or other contributing ailments but just from lifestyle and behavior?

If a person were to suddenly start doing all the wrong things, roughly how long before the effects show up in a stress test?

Not planning on trying this out myself, just wondering.

posted by trinity8-director to health & fitness (12 comments total)

This depends entirely on the genetic makeup of the individual. There are people who can eat like shit, smoke, and get minimal exercise their entire lives and never have symptoms of heart disease. There are nonsmokers in good shape and with reasonable diets who have heart attacks at 50.
posted by mr_roboto at 5:08 PM on September 18, 2008

There are people who can eat like shit, smoke, and get minimal exercise their entire lives and never have symptoms of heart disease.

That's my family, including an older brother who smokes. I don't recall even hearing of heart disease in my ultra-sized extended family. Dad hasn't exercised in maybe 30 years and at 83 has problems but not the pumper.
posted by trinity8-director at 5:15 PM on September 18, 2008

how long would it take to go from a perfectly healthy heart to one in grave danger

About five minutes. That's how long it takes after you stop breathing before irreversible cell damage begins.
posted by Class Goat at 5:58 PM on September 18, 2008 [2 favorites]

The problem is that "passing" a stress test - as a "healthy heart" is not a good indication of heart heath. It really only shows serious problems. There is a better test now, a CT angiogram (CTA), that uses a high resolution CT scanner and gets a closer look a the coronary arteries. The results of a CTA can show whether or not there are blockages in the arteries of the heart to a degree that are often missed on a stress test. It is much more sensitive and can detect issues many years in advance. It can also tell you what kind of plaque is in your arteries and the degree of calcification. If you really want to know your baseline heart health, a stress test isn't going to cut it.
posted by hazel at 8:42 PM on September 18, 2008 [1 favorite]

The problem is that "passing" a stress test - as a "healthy heart" is not a good indication of heart heath. It really only shows serious problems. There is a better test now, a CT angiogram (CTA), that uses a high resolution CT scanner and gets a closer look a the coronary arteries. The results of a CTA can show whether or not there are blockages in the arteries of the heart to a degree that are often missed on a stress test. It is much more sensitive and can detect issues many years in advance. It can also tell you what kind of plaque is in your arteries and the degree of calcification. If you really want to know your baseline heart health, a stress test isn't going to cut it.
posted by hazel at 10:42 PM on September 18

Exactly so.

I had a heart attack in 1999, knew I was in trouble, but denial is thick -- I was healthy, fit, fair diet, lots of exercise, blah blah blah. Went to my regular doc, he found nothing, sent me to The Austin Heart Hospital, they did a stress test, found nothing. In 2004 I was dead as Dillinger, from a blocked cardiac artery, which would have been found using a CT angiogram, and they'd have popped a stent in, I'd have gone on about my way, all smiles and festivity.

About five minutes. That's how long it takes after you stop breathing before irreversible cell damage begins.
posted by Class Goat at 7:58 PM

I'm not sure if it's five minutes but I'd bet that's close. Best we can figure I was dead without oxygen for about eight minutes, then dead another thirteen minutes before they got a heartbeat, but was at least on a vent with CPR etc and etc during those thirteen minutes, and getting oxygen to my heart and brain. I definitely have permanent damage to tissue in one area of my heart, but nowhere near as bad as it could have been. I'm lucky, to be sure. (Also brain damage, my sense of smell gone, but that's not a bad trade-off for being able to be alive and kicking around in Austin -- I'll take it.)

Take care of yourself. Dying is a huge pain in the ass, gets your family and friends all worked up, takes time to recover, huge expenses, etc and etc. Yeah, it's fun being the center of attention and all, and gives you some great stories to tell; regardless all that, I'd stay away if I could, and mostly we can, through diet, exercise, cholesterol medication(s), lowering stress levels, etc and etc.

If you have even the slightest suspicion that you've got something going on i your heart, go ahead and insist upon the CTA; you can tell them I told you so, and hazel did also. Don't let them bully you into accepting their jive about how it's not needed, blah blah blah -- if I'd have had it I'd not have gone through all kinds of shit. Perhaps if the technology had been available in 2000, or whenever it was that I showed up at the heart hospital they'd have given me the test, though there's no guarantee, aside from me jumping up and down and insisting upon it. I've made all my brothers and sisters take that test -- they don't get to die if I don't get to die, plenty of time for this bullshit later on down the line.
posted by dancestoblue at 10:23 PM on September 18, 2008 [4 favorites]

The echo is bullshit and is misleading. It often shows nothing, even DURING a heart attack. The only (mostly) foolproof to identify and really diagnose a problem is an actual heart cath - angiogram - and while it may sound scary to have a wire stuffed into your cardiac arteries, they do it through a tiny incision in the groin now and assuming they don't have to do any plasty to fix problems they find, it can be done in 30 minutes or less.
posted by luriete at 10:58 PM on September 18, 2008

Aside from my favoriting what dancestoblue had to ay, I'd rather like to hear what ikkyu2 has to say. This is, like, a 'doctor' question. But obviously not from YOUR doctor on here.
posted by matty at 11:25 PM on September 18, 2008

Since you are talking about a stress test, I assume you are concerned mainly with ischemic heart disease (i.e. "heart attack"); it is important to note that there are a whole host of problems that can occur with the heart such as valve dysfunction and arrhythmias that won't necessarily show up on a stress test (although a competent physician will know to look for them based on the history and physical).

It has been known since the 1950's that by 10 years of age many people in the US show fatty streaks in their aorta and/or coronary arteries (this is why cardiologists have been concerned about childhood obesity and diet for decades; I am glad the rest of us are beginning to catch on). Autopsy studies consistently show that by age 15 everyone has early signs of atherosclerosis. Where it goes from there depends on both lifestyle and genetics, and it is a continuous progression; you are not healthy one day and gravely ill the next; you are instead slightly more at risk every day until an acute event (usually a blood clot) completely obstructs an atherosclerotic artery. At that point you may not even know you have had a heart attack (a "silent myocardial infarction", especially common in diabetics due to neuropathy), you may have the classic scenario of crushing chest pain, sweating, and shortness of breath, or you may drop dead due to ventricular fibrillation (sudden death is the first sign of heart disease in about half of the people who have it). Or anything in between, or have other symptoms, depending on what part of the heart is affected. There are case reports of healthy people in their twenties with no risk factors having near fatal heart attacks, so at a minimum, assuming the process begins shortly after birth, it can take 20 or so years if you have no risk factors, even less if you have diabetes, smoke, have hyperlipidemia of some type, and so on. The risk continues to climb every year after that with heart attacks being most common in people in their 50's, 60's, and 70's. So the answer to your question depends on how old you are and how far you are already along in this progression. The answer to the latter question can only be gotten definitively by taking out you heart and opening the coronaries to look at their insides. Obviously this is not practical, so cardiologists try to guess what is going on with tests such as stress echos and coronary angiography. Unfortunately, although a negative test does give some indication that you are in good shape for now, you may just be a few months, weeks, or even days from progressing to the point where the test will show different results. So to sum up, the answer to your question is "it depends".
posted by TedW at 5:08 AM on September 19, 2008

The echo is bullshit and is misleading. It often shows nothing, even DURING a heart attack. The only (mostly) foolproof to identify and really diagnose a problem is an actual heart cath - angiogram - and while it may sound scary to have a wire stuffed into your cardiac arteries, they do it through a tiny incision in the groin now and assuming they don't have to do any plasty to fix problems they find, it can be done in 30 minutes or less.

I don't want to derail this but I can't let this comment stand without adding some thoughts. Echocardiography is actually one of the best ways to detect ischemia; the regional wall motion abornomalities it picks up show up even before EKG changes are eveident. That said, it does depend somewhat on the skill of the operator and in some patients it is easier to visualize the heart than in others, so like all tests it is not 100% sensitive. It is not "bullshit" either, though. While coronary angiography is usually thought to be "the gold standard" when it comes to diagnosing coronary artery disease, it too can miss the diagnosis, especially in Prinzmetal's angina. On top of that it is an invasive test that involves sticking a rather large needle in one of the largest arteries in the body; there are a number of fatal and near-fatal complications that can occur. Fortunately they are not common, but undergoing a cath is by no means a trivial procedure.
posted by TedW at 5:20 AM on September 19, 2008

All answers appreciated, thank you.

I have had (and occassionally still do have) esophagitis but my MD wanted to rule out heart issues since the two often present similar symptoms.

Nevertheless, as I approach the time for my 50,000 mile checkup I am now considering the CTA for peace of mind if nothing else. It is probably the only way to prevent the minor freak-outs when the esophagitis flairs up and the what-ifs start playing in my head.
posted by trinity8-director at 11:48 AM on September 19, 2008

I have had (and occassionally still do have) esophagitis but my MD wanted to rule out heart issues since the two often present similar symptoms.

That is a significant statement; back when I did adult cardiac anesthesia I saw many patients who were originally scheduled for Nissen fundoplication (heartburn surgery) that on further workup actually were having angina rather than heartburn and ended up in the OR for a bypass. The diagnosis is further complicated by the fact that nitroglycerin relieves the esophageal spasm associated with reflux/heartburn and so confounds the diagnosis of angina vs. heartburn. Your physician is doing well to consider heart disease presenting as gastrointestinal symptoms.

I am now considering the CTA for peace of mind if nothing else. It is probably the only way to prevent the minor freak-outs when the esophagitis flairs up and the what-ifs start playing in my head.

If you are overly concerned with your health, then any given test is unlikely to soothe your worries; every medical test has its limits. Learning about and modifying your risk factors as well as learning to pay attention to your body will pay bigger dividends in the long run.
posted by TedW at 5:32 PM on September 19, 2008

So I got the CT Coronary Artery Calcium scan on Friday and the results just now. Scored a very lovely zero.

Is that the Ultimate Coronary Test of All Time? No, but its still good to know.
posted by trinity8-director at 5:37 PM on September 29, 2008