How to spot your coming heart attack

One of the biggest developments in medicine promises to dramatically decrease the number of people dying from heart attacks.

After ironman Dean Mercer died of a heart attack recently, several of his fellow competitors reportedly said they were off to get their hearts checked. What they probably didn’t know was that it’s now possible to detect impending heart problems well before the symptoms manifest themselves, enabling you to take preventative action that could save your life.

Big advances in the use of CT imaging technology means cardiologists can now see the beginnings of cardiovascular disease in stark visual detail years before telltale symptoms (from simple chest pains to actual heart attacks) announce you’ve got a serious problem.

The ability to remove the guesswork about your risk and take preventative action has long been a dream for cardiologists. But no longer. If you really care about your cardiovascular health, you can now take steps to dramatically reduce your risk of heart disease.

Why Cardiac CT scanning is important

Until now, doctors have been using indirect indicators, such as high cholesterol, high blood pressure, diabetes, smoking, lack of exercise and poor diet, to make a prediction on your chances of suffering from cardiovascular problems. These predictions are based on population studies — for example, if you have high cholesterol, then you have a raised risk of a heart attack, based on an average of people with high cholesterol who’ve had heart attacks.

This way of predicting risk is wildly inaccurate. High cholesterol is no guarantee that you’re in for heart problems, for instance. It also leads to an under-prediction of risk in high-risk groups and an over-prediction in low-risk groups.

This is what plaque in an artery looks like. This cardiac CT scan shows dangerous “soft” plaque which can burst and lead to a heart attack.

A cardiac CT scan, on the other hand, pinpoints the exact locations in your arteries where cholesterol has built up in plaque deposits and could turn dangerous. You can see the problems with your own eyes.

Why it’s really important

The truth about cardiovascular disease is that it’s not just related to poor lifestyle choices. Genetic factors and family history can kickstart heart disease even in people with exemplary health and fitness. Just because you’re fit and eating well, don’t smugly assume you’re immune from potential heart problems.

There’s a long history of very fit people suffering heart attacks — just this year Bob Harper, the super fit host of Biggest Loser America, barely survived a massive heart attack while in the gym at just 51 years of age. In Australia, personalities other than ironman Dean Mercer whose unexpected heart problems have surprised the nation have included cartoonist Bill Leak and TV comedian John Clarke, who both died of heart attacks earlier this year, and TV personality Andrew Denton, who has undergone heart surgery.

And a chilling new study in the European Journal of Preventive Cardiology has revealed that in 695 heart attack patients at Sydney’s Royal North Shore Hospital three out of ten exhibited none of the traditional risk factors. In order words, despite going on to suffer heart attacks, they would have been given a clean bill of health by traditional methods of assessing heart risk.

Even more worrying was that the percentage of heart attack sufferers with no known risk factors more than doubled in the time covered by the study, from 11 percent in 2006 to 27 percent in 2014.

The bottom line is that CT scanning is the only way of picking up heart problems in people who exhibit none of the traditional heart risk factors, and as result, now has a strong push behind it from many in the medical profession.

Who’s driving the Cardiac CT scanning trend?

Dr Warrick Bishop.

One of the cardiologists leading the discussion about precision of risk assessment is Dr Warrick Bishop, who has written a book on the topic called Have You Planned Your Heart Attack? “With the knowledge we have today, we can start treating someone with impending heart disease before the symptoms appear,” Dr Bishop writes in his fascinating book.

Dr Bishop employs two types of cardiac CT test. The first looks for calcium deposits in the arteries, giving you what’s known as a coronary artery calcium score (CCS). Calcium builds up in arteries in areas where plaque occurs and is an accurate predictor of heart disease risk, says Dr Bishop. If you have a very low calcium score your risk of a heart attack is virtually zero. But as it goes up the risk grows exponentially. Dr Bishop calls the CCS the “gatekeeper test”.

If you have a high CCS you move on to a full CT coronary angiography. This lets doctors find and assess the structure and characteristics of individual plaques. It’s performed with a CT scanner and contrast dye. On screen, it shows a 3D structure of the arteries and highlights any plaque deposits, which appear as visibly different spots on the scan.

What causes plaque?

Plaque is a build-up on an artery wall that fills with cholesterol, scavenger cells, calcium and scar tissue. It forms when the endothelium — the inner layer of an artery — suffers some kind of damage. Special cells called leukocytes rush to the site to repair the damage, followed by cholesterol, which is needed to build cell walls.

The problem happens when the plaque deposit keeps on growing and obstructs the blood flow. It can turn deadly if it bursts because the body rushes clotting agents to the site which can block the artery and cause a heart attack. A cardiac CT scan can spot the unstable plaques and prevent a disaster.

Who should be screened?

Dr Bishop says that if you have a family history of early onset cardiovascular problems you should already be speaking to your doctor about tests and management regardless of age. Otherwise, men should have a scan when they reach 50, no matter how fit they are. Women should get a test at 60. Women’s risk is 10 years behind men’s because female hormones such as oestrogen tend to protect against plaque. These decline after menopause.

Our test

A cardiac CT scan being performed at Medscan Barangaroo, one of Australia’s most advanced imaging clinics.

We tested the cardiac CT imaging on two people for this story. Both very fit, we wanted to know whether that would have protected them from any heart disease. We went to the Medscan clinic in Sydney’s Barangaroo, which has some of Australia’s most advanced medical imaging facilities.

Test 1: Fit male
Michael is a senior executive in his 40s who trains every day. With a body fat percentage of 9.2%, he is very fit. He also has a very healthy diet, which makes him even less of a candidate for a heart attack. The result? The scan showed he had a single tiny plaque deposit in one of his arteries, proving that even the fittest people are not immune to plaque. The good news is that his plaque was insignificant and the rest of Michael’s cardiovascular system was “pristine”.

That tiny yellow dot is the single plaque found in one of our fit man’s arteries.

Test 2: Fit female
Christine, also in her 40s, is a sales executive and serious runner. Women don’t tend to get as much plaque as men until after menopause when their protective female hormones decline. The result? No plaque or sign of any cardiovascular problem. There was no better advertisement for a lifetime of running than Christine’s 100% clear result. We asked her about her nutrition, and she said her policy was to eat everything in moderation.

Have You Planned Your Heart Attack?
Written by cardiologist Dr Warrick Bishop, Have You Planned Your Heart Attack? (RRP $34.99) provides readers with an easy-to-understand, research-driven and proactive approach to preventing cardiac disease. Dr Bishop provides an insight into modern coronary risk assessment and why we need to take a more holistic, preventative approach that utilises the latest technology to deal with risk through investigation and management.
Have You Planned Your Heart Attack? is now available at all good book stores and online at


To win one of four copies of Have you Planned Your Heart Attack, go to our Fitness First mag Instagram page at @fitnessfirstmag, and post something that makes your heart race, under the hashtag #magmyheartrace.

Our editorial panel will announce the winners on Monday, October 23.