Testing Will Detect Silent Heart Disease

When famous athletes such as basketball star Hank Gathers or runner Jim Fixx drop dead exercising, everyday exercisers may stop in their tracks. Are recreational athletes risking sudden heart failure while chasing their personal fitness goals?

For everyday exercisers, cardiologists offer reassurances--and caveats. “Sudden death (from heart problems) is extremely rare in young people,” said Dr. Harold Karpman, a Beverly Hills cardiologist and author of “Preventing Silent Heart Disease” (Crown Books).

“People under age 30 (who have sudden heart attacks) typically die of structural heart defects, usually congenital in nature,” agreed Dr. Steven Van Kamp, a San Diego cardiologist and medical director of the adult fitness program at Cal State San Diego.

Although the sudden deaths of young athletes grab headlines, Karpman said it is far more common for older people to die suddenly from what he and other experts call “silent heart disease,” which may affect millions of Americans. Technically called silent myocardial ischemia, the condition involves a decrease in the supply of blood to the coronary artery. This shortage can occur even when there are few fatty deposits on arterial walls and even when there are none of the traditional symptoms, such as chest pain.

People older than 30 who suffer sudden heart attacks while exercising typically have coronary artery disease, said Van Kamp. The key, agreed Van Kamp and Karpman, is to assess individual risks. “The five most important risk factors for coronary artery disease are age, gender, blood pressure, cholesterol level and smoking habits,” Van Kamp said. “Look at these and you can profile your own risks. A man who is 55 and smokes two packs of cigarettes a day needs testing even if his only exercise is taking out the garbage. But a 26-year-old women with no risk factors should be considered low risk.”

Once you know your risk profile, there are basic common-sense guidelines to keep in mind, Van Kamp said. If your blood cholesterol level is borderline, have the test repeated every year. If it’s below 200, repeat it every five years. Get a resting electrocardiogram if you’re older than 30 and about to begin an exercise program. Have a treadmill test if you have multiple or severe risk factors for coronary heart disease.

“If you’re over 45, you should have a treadmill test before starting a vigorous exercise program or if you’re over 35 and have risk factors,” Van Kamp said.

POINT / COUNTERPOINT

Silencing the Snorer

It’s an old saw but not always a pleasant bedtime story: Laugh and the world laughs with you. Snore and you sleep alone.

What to do? Here’s what two experts, Drs. Philip Westbrook and Derek S. Lipman, have to say about some popular home cures for snoring. Both physicians caution, however, that some snorers require professional help. Seek a doctor’s help if snoring is loud and intermittent or if daytime sleepiness is common. Both can signal sleep apnea, a potentially serious sleep disorder.

Dr. Philip Westbrook, director, Sleep Disorders Center, Cedars-Sinai Medical Center, Los Angeles:

“The initial remedy I talk about is changing the sleep position. One of the simplest ways is to take a tennis ball, put it in a sock and pin it to the back of the pajamas. That makes it too uncomfortable to sleep on the back, the most common position during snoring. Weight loss is another important aspect. Avoid alcohol and other central nervous system depressants like sleeping pills before bed. They are known to make snoring worse. Treat the nose locally with anti-inflammatory medications. But avoid decongestants because their use can lead to more problems down the road, like the ‘rebound’ effect in which symptoms become worse over time. Give your bed partner ear plugs.”

Dr. Derek S. Lipman, ear-nose-throat surgeon, Portland; author of the forthcoming “Stop Your Husband From Snoring” (Rodale Press)

“To breathe comfortably at night, without snoring, you must have a clear nose--an open nasal airway. To achieve that, sleep in a cool, well-ventilated room. Keep your head elevated by using an extra pillow or raising the head of the bed several inches. Moisturize the nasal airway with simple, sterile saline sprays, available over-the-counter. Spray your nose liberally before going to bed. If you have persistent nasal congestion, see an ear-nose-throat doctor.”

SHOP TALK

Collaring Exercise Meltdown

So much for the old “It’s-too-hot-to-exercise” excuse. Now there’s Kool Kollar, an ice cube-filled terry cloth device worn around the neck.

Made by a Dallas company, the Kool Kollar was originally used by golfers playing muggy Texas courses. By next month, the collar will be distributed nationwide through sporting goods and drug stores, said Frank Muskeni, spokesman for American Fitness, a Sherman Oaks-based distributor. It costs $9.95 and lasts three or four years.