Is treadmill test enough to know heart health? Neurologist shares how 55-year-old man had heart attack after passing it

A treadmill stress test highlights obstruction in the arteries; however, it does not draw attention to the vulnerable areas, according to Dr Kumar.

A treadmill stress test reveals how an individual’s heart functions during physical activity. It is a medical tool that helps physicians spot anomalies, if any, and decide on a course of treatment.

However, the test has its limitations, and over-reliance can result in serious flaws in diagnosis, explained Dr Sudhir Kumar, MD, DM, a neurologist at Apollo Hospitals in Hyderabad. Taking to X on March 27, he shared a case study to explain how a normal treadmill test result can lull an individual into a false sense of security that can be dangerous later.

Case study of treadmill test failure

Dr Kumar recalled the case of a 55-year-old man who sought medical attention after experiencing intermittent discomfort in his chest. His local physician performed a treadmill stress test; when the results were normal, he was reassured, and no further tests were performed.

Trouble arrived six weeks later, as the man suffered an acute Myocardial Infarction (heart attack). “Coronary angiography showed significant multivessel Coronary Artery Disease (CAD),” shared the physician.

Neurologist’s reading of the situation

According to Dr Kumar, missing out on the possibility of a heart attack was not a failure of the treadmill stress test. Rather, it is the shortcoming of the healthcare professional for not understanding the limitations of the test.

“Treadmill test detects flow-limiting obstruction (in the arteries),” stated Dr Kumar, which is a late disease. The test does not detect the plaque burden on the cardiovascular system or the vulnerable plaques.

Plaque is the deposit of fat, cholesterol, and other substances within the walls of the arteries. “Most heart attacks occur due to rupture of non-obstructive plaques,” noted Dr Kumar. Therefore, even when one passes the stress test, they can remain at risk of cardiac arrest.

The bottom line, as per Dr Kumar, is that a normal stress test rules out ischemia (insufficient blood flow to tissues), but not atherosclerosis (plaque build-up in arteries).

How does a treadmill stress test work?

According to the Cleveland Clinic, the treadmill stress test typically involves the following steps:

• Vitals of the participant are taken at rest
• Patient begins walking on a treadmill
• Vitals are recorded every three minutes as the intensity of the treadmill increases
• The exercise is continued until the participant reaches or nears maximum heart rate
• It is followed by a gradual cool-down period

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

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