The Stress Test: Know Your Heart Attack Risk

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HUNTSVILLE, Ala. (WHNT) – More than 26 million people have been diagnosed with heart disease, and experts believe more than twice that many have it and don’t know it. The cardiac stress test is one of the primary tools doctors use to diagnose heart disease. But recently, one of our own learned the stress test can completely miss potentially deadly problems.

WHNT News 19's Al Whitaker almost didn't live to tell this story. He was forced to take a couple of months off last year to undergo triple cardiac bypass surgery.  He initially took a stress test and it didn’t reveal any problems.

Below is Al's account, in his own words.

The nurse called the day after I took my test last October and told me everything looked fine. Hundreds of people get that same phone call every year, not knowing that their stress test might have missed the heart problem destined to kill them.

The statistics are amazing. Heart disease is the leading cause of death in the United States. One out of every four people who die in this country die of heart disease. That’s over 600,000 people a year. It means thousands of Americans are walking around today with a silent killer inside of them, and the tragedy is many of those deaths could be prevented.

That’s the focus of Dr. Enrique Velasquez, a cardiologist at The Heart Center in Huntsville.

“In your case, the blood flow to the entire heart was diminished,” Velasquez told me. I went to see Dr. Velasquez in October. Based on my symptoms and other factors he scheduled a stress test.

In the basic stress test, the heart is monitored both at rest and during physical exertion, usually while the patient is on a treadmill. It’s designed to identify subtle changes in the function of the heart, changes that would cause the physician to want to investigate further. In my case, however, it found nothing.

The defining moment for me came the day after the test when the nurse called and said everything looked fine. It could have ended there, but I insisted 'everything’s not fine, there’s definitely something wrong.'

How severe was my situation? "It was very severe," Velasquez told me. “You already had a history, a previous history and so the pre-test probability of you having the disease was much higher than somebody else. The symptoms also, the type of symptoms, when the patient is telling you this feels like my heart pain, angina, then you’ve got to go with the clinical side,” Velasquez said.

That meant another test -- an angiogram where a small probe is inserted into the femoral artery and pushed up through the body toward the heart. Only then could they see exactly what was going on and what the stress test had missed… A right main artery – completely closed, the left main almost completely blocked.

“Some people refer to it as the widowmaker," said Dr. Velasquez. "The problem there is that artery gives circulation to about two-thirds of your heart. So most patients when they have an event or a heart attack from that location, they will not survive, even to come to the hospital.”

Dr. Velasquez explained my stress test failed to show any problems because my entire heart was starved for oxygen, so the changes brought on by the test appeared normal. But as with all medical tests, he says the results have to be taken in context with other factors.

“So you’ve always got to put into context, the patient, his risk factors, his history, and what they’re telling you,” Velasquez said.

Now, we’re not throwing the stress test under the bus here. It is one of the most valuable tools cardiologists have at their disposal, but you need to understand it is not the definitive test. If you’ve had a stress test and got a good report from it, congratulations. But if you’re still having symptoms, no matter how minor they may seem to be, your life may depend on making certain your doctor understands exactly how you’re feeling.

"The story that we get from the patient is what's really going to tell us, I really think this person has a problem and I've gotta go one step further," Dr. Velasquez said.

Sometimes, that one step will mean the difference between life and death.

Are there other tests that can help doctors detect heart disease? Yes. I mentioned the angioplasty earlier, it’s extremely reliable but it has risks, and your doctor will have the weigh the risks against the potential benefits.

There’s also a Coronary CTA test. It’s a CT scan, so there’s radiation involved. The least invasive and safest test is still the stress test.

Here is some additional information from the American Heart Association on heart attack risk and improving your heart health.

-Warning Signs of Heart Attack, Stroke & Cardiac Arrest

-What's Your Risk? Heart Attack Risk Assessment
For this test, you will need to know your most recent blood pressure reading as well as cholesterol & triglyceride levels. The test will give you a risk result (your risk level of having a heart attack in the next 10 years) as well as an action plan to cut those chances and improve your health.

-Heart Healthy Quizzes
Improve your knowledge about living well and fighting off heart disease and stroke. These quizzes test your knowledge on heart health and will likely teach you something new.

-Heart Health FAQ: Stress Tests, Heart Attack Risk
Read frequently asked questions about stress tests and who needs them, risk associated with family history of heart disease and more. Answers provided by Dr. Enrique Velasquez of The Heart Center in Huntsville.


  • Nuclear Mike

    A confusing article…so if you tell the cardiologist you are ‘sick’ then you get saved regardless of the test results????

  • Al Whitaker

    Essentially you’re exactly right, Mike. One of the key points Dr. Velasquez made during our interview with him is the importance of communicating with your doctor. What the patient tells him, he says, is often one of the determining factors in whether they feel it necessary to “take the next step” and order additional tests for a patient. He says some patients actually downplay their symptoms. The point being the patient, especially with regards to cardiac symptoms, must convey to the doctor exactly whats going on, how they feel, what their symptoms are because quite often those symptoms are very subtle and typically vary from one patient to the next. In my case, the stress test results showed “everything looks fine.” I insisted everything was not fine and that resulted in the doctor ordering a much more invasive test that revealed the life-threatening blockages that required bypass surgery to repair. I hope this helps, thanks for your note.

    • Peggy J Boyd

      In 2004 I had a stress test done~ on Thursday the results came back great flow in and out. On Sunday of that week my indigestion became worse. I went to Huntsville Hospital. On arrival I gave them my stress test. When they started to check me I started having a heart attack! I ended up with 4 stints that night. Thank the Lord I was already at the hospital.

  • Al Whitaker

    Peggy, you wouldn’t believe how many stories like yours we’ve heard in the past few weeks. I hope you’ll stay in touch with your cardiologist. If your stents are 10 years old, you might consider getting checked again. The stents themselves will clog in time and other blockages may develop. The symptoms typically develop very slowly so they’re not as noticeable until the problem is acute. Make certain you tell your cardiologist of your history, and don’t assume he’s read your file. And if you’re having any symptoms, regardless of how minor they may seem at the time, tell him… Make certain he hears you. Thanks for sharing your story and let us hear from you if anything new develops.

  • Amy

    I’ve not had a stress test yet. I’m 51 yo, female. I was diagnosed with neuropathy Tuesday. The specific type of neuropathy is yet to be determined as well. I have yet to be tested to see if I’m diabetic.

    The main and only problem is this. No matter what doctor you see for whatever ailment, DOES NOT LISTEN to what you have to say. When you speak up and the doctor finally listens, then the doctor will investigate. Some doctors think they know it all when the PATIENT KNOWS ITS OWN BODY and knows that something is not right.

    For example, like today, I went to the doctor because of sneezing, coughing with such force my chest felt like it was on fire, and hoarseness. I couldn’t talk above a whisper without getting out of breath. I told the doctor that I have had bronchitis too many times in the past that I know the signs. He asked me, what was done about it? I told him, in the early stages like today, a shot and some meds then I go home. That is what he did. I have my voice back and I’m not coughing as much.

    I just wish that everyone would just listen to their own bodies. If you have a “gut feeling” that something is not right. Please, go to your doctor and tell them so. If they give you the impression that it’s all in your head keep after them until they do listen.

    Al, I’m glad you are still with us today. You are an example of what I was just saying. You made your doctor listen to you because of your “gut feeling”. I want to stand and applaud you for doing that. May you get through to other people as well.

    • Al Whitaker

      Amy, I strongly support what you’re saying. Some doctors will tell you they rely upon gut instinct, theirs and the patients’, in diagnosing some problems. If you get the notion your doctor isn’t paying attention, tell him, challenge him, ask questions. And if you’re not satisfied, go to a different doctor! Good luck to you!

  • Skillpot

    Okay, a ‘stress test,’ I am not convinced that is the best way to go? Having had several done in the past, but not one in several years, seems angioplasty is the best approach? I went to hospital in Dec 1998 with heart problems. Seems, I recall that the cardiologist was able to determine that I needed heart surgery (turns out 3-bypasses were done), but I was told “…picture machine is down, but you cannot go home…!” I have always questioned whether I needed bypass surgery? Would angioplasty, with stints, not been the best way to go? Remember, the process of open-heart, where you are cut open, leaves you down for some time, BUT, there is more money to flow to the hospital, and surgeon!

  • Al Whitaker

    I still believe the stress test is a good starting point but passing it should probably not be interpreted as a clean bill of health, especially in the presence of unexplained symptoms. As for your question, heart disease remains the number one cause of death in the US, meaning there’s no shortage of patients. There would be a room full of staff, including other physicians, so any doctor who would perform unnecessary procedures would eventually get called out on that. Regarding your stents, certainly, getting a stent or two would be a much easier procedure but a lot of factors are called into play to make that decision. My surgeon explained if one of my blockages had been an inch or two further away from the heart, the proper protocol would have been to install a new stent. However, he said he was glad they did the bypass because they were able to correct other problems while they were in there. Hope this helps, thanks for your note.

    • Skillpot

      Al, you are correct in that a ‘stress test’ is important, BUT, from recent experiences, the angioplasty, not only through the groan, but, through the wrist seems to be the way to go? A stress test only tells one in how good physical shape you are in! What about the EKG? Seems the EKG will show more than the ST? Remember, the ST, AP, EKG, and OH are all good money makers!

      • Paul

        Agree, the stress test in it’s self is not complete. That’s why you need the CTA along with the stress test to really see what’s going on. EKG’s for me were normal when in fact I had lots of issues which the Stress/CTA help indicate.

  • Paul

    Al, I surprised that they didn’t do the CTA test at the same time that they are doing the stress test. My cardiologist always runs them together. That lead to the Heart Cat which showed I had problems that required the by-pass. I had Quad By-pass in July 2012 and it was the CTA part of my stress test that set off the alarms.

  • Jan Thatcher

    We are fortunate to have so many excellent cardiologists at the Heart Center who save lives everyday. Teamwork is a physician who works with his patient to reach a diagnosis and treat it successfully. Way to go Huntsville Hospital.

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