Cardiologist Dr. Paul D. Thompson, MD, explains why vigorous exercise can briefly raise the chance of a heart attack, why he still recommends exercise, and which new symptoms during exercise call for a doctor.
Exercise and the Heart: Short-Term Risk, Long-Term Gain, and Warning Symptoms
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- Exercise benefits and short-term risk
- How hard exercise can trigger a heart attack
- When the risk is raised
- Symptoms to notice during exercise
- When to see a doctor
- Full Transcript
Exercise benefits and short-term risk
Exercise carries both benefit and risk. Asked by Dr. Anton Titov, MD, how a patient should weigh them, Dr. Paul D. Thompson, MD, says the benefits far exceed the risk, but that there is risk.
He compares exercise to investing in the stock market: people invest for a long-term gain, yet a stock can suddenly go bankrupt. He also jokes that anyone who wants to spend the next hour as safely as possible should go to bed alone.
How hard exercise can trigger a heart attack
Coronary arteries move with every heartbeat, which Dr. Thompson describes as the probable reason for the risk. When they contain cholesterol deposits, he says, they are bent back and forth like a rubber hose.
A rubber hose that is bent can crack. In his explanation, bending a coronary artery too vigorously during vigorous exercise can crack the cholesterol plaque, causing a blood clot and a heart attack.
When the risk is raised
The raised risk is brief. Dr. Thompson says exercise acutely increases the risk of a heart attack and sudden death while a person is exercising and for up to an hour afterwards. Overall, however, he says exercise reduces the risk of a heart attack or sudden death, and he recommends that people exercise.
Symptoms to notice during exercise
New symptoms during exercise are what Dr. Thompson asks people to watch for. He names undue shortness of breath and discomfort in the chest. He avoids the word pain because, he says, it is often discomfort rather than pain.
When to see a doctor
Seeing a doctor is his advice when new symptoms appear during exercise, especially discomfort that comes on with exercise and goes away with rest. People pay doctors to answer their questions, he says, and they are not the doctor. His advice is to have such symptoms evaluated without hesitation, because peace of mind is worth a lot.
Full Transcript
Dr. Anton Titov, MD: Heart attack during exercise, the risk of sudden cardiac death during exercise. You were first author of a scientific statement on exercise and acute cardiovascular events. Regular exercise protects the heart, but vigorous exertion can briefly raise the risk in susceptible people. Heart attack and cardiac arrest are most likely in inactive people who suddenly exert themselves. Professor Thompson, how should a patient weigh exercise risk against exercise benefit? Which symptoms during exercise need a doctor?
Dr. Paul D. Thompson, MD: The benefits of exercise far exceed the risk, but there is risk. I say it is like investing in the stock market. You invest in the stock market to get a long-term gain.
Dr. Paul D. Thompson, MD: You exercise to get a long-term gain. But the stock you bought may have a problem all of a sudden and go bankrupt. The same thing happens with exercise.
Dr. Paul D. Thompson, MD: There is risk while you are doing vigorous exercise. When people ask me, I say: if you want to spend the next hour as safely as possible, go to bed alone. But if you exercise or you are vigorously active, you increase the risk of disease.
Dr. Paul D. Thompson, MD: Now, we have studied this, and what probably happens is this. Remember these coronary arteries; they are called coronaries because they crown the heart. As your heart is beating, these coronary arteries have to go along for the ride. So if there is cholesterol, atherosclerosis, in these arteries, those arteries are being bent back and forth like a rubber hose.
Dr. Paul D. Thompson, MD: What can happen if you bend a rubber hose? You can get a crack in the rubber hose. What can happen if you bend a coronary artery too vigorously during vigorous exercise?
Dr. Paul D. Thompson, MD: You can get a crack in the cholesterol plaque, a blood clot, a heart attack. So exercise does acutely increase the risk of a heart attack, acutely, shortly while you are doing it, for up to an hour afterwards, and sudden death.
Dr. Paul D. Thompson, MD: But overall, exercise reduces your risk of a heart attack or sudden death. So I recommend that people exercise. What should you pay attention to?
Dr. Paul D. Thompson, MD: You should pay attention to new symptoms during exercise that are new. Undue shortness of breath. Shortness of breath you are not used to.
Dr. Paul D. Thompson, MD: Discomfort in your chest. Notice I did not say pain, because it is often discomfort and not a pain. But if you have a question, you pay doctors to answer your questions.
Dr. Paul D. Thompson, MD: You are not the doctor. So if you have new symptoms during exercise, especially if you have discomforts that come on with exercise and go away with rest, do not hesitate to talk to somebody about it. See your doctor and get it evaluated.
Dr. Paul D. Thompson, MD: Peace of mind is worth a lot.