In this Heart Health Alert, cardiologist Dr. Roger S. Blumenthal answers questions on heart health and exercise from two readers who exercise regularly, but still have concerns. These questions come from a recent issue of The Johns Hopkins Heart Bulletin.
Q. Is it a dangerous to exercise if I am having angina pains? I am a 55-year old longtime runner, and I recently "ran through" the pain during a 5K-road race. Is it unwise to continue a workout when I’m having chest pain? Shaker Heights, OH
Dr. Blumenthal: Angina -- chest pain or discomfort that occurs when an area of the heart muscle doesn't get enough oxygen-rich blood -- is a symptom of an underlying heart problem. That said, anginal pain itself is not a contraindication for exercise. In fact, a certain amount of regular exercise may help develop new blood vessels to the area of the heart where arteries are blocked. However, you should discuss with a physician your level of exertion and target heart rate. This is especially important if the degree of blockage is significant.
Like all muscle, the heart needs more oxygen during exercise, and strenuous exercise can cause an imbalance between oxygen demand and supply in the diseased portion of the heart; this can lead to serious consequences in some cases. If you are truly having anginal pains, you need to make sure that you are on an optimal medical regimen -- to repeat, you need to consult your doctor.
Q. I had a scare while lifting weights two days ago. I was bench-pressing 300 pounds, and my heart rate was close to maximum for me when I suddenly felt a sharp pain in my left side. I stopped my workout immediately but my heart rate remained elevated; I was wearing a heart-rate monitor and it showed that my pulse remained at 135 beats per minute for the next 15 minutes before dropping down to my usual resting heart rate of 60. I am a 49-year-old man and I have been weight lifting three times a week since my Marine Corps days, 25 years ago. My cholesterol level is under 200, I am a vegetarian, and I have no heart problems that I am aware of. However, I am now afraid to lift weights. Should I see a cardiologist? What tests should be performed? NYC, NY
Dr. Blumenthal: You certainly should see a doctor to try to determine the origin of your sudden pain, which may or may not be heart-related. Unfortunately, a middle-aged man, even with cholesterol relatively under control, may still be at risk of heart attacks and strokes.
Your optimal cholesterol level will depend on your overall cardiac risk, and your doctor will need to consider other factors, such as the details of your lipid profile (HDL, LDL, triglycerides), your blood pressure, and the possible presence of diabetes. The doctor should of course take a detailed family history, making note of any cardiac disease in your immediate and extended family. Based on your physician’s assessment, other tests may be warranted. These may include further blood tests for C-reactive protein and a noncontrast CT scan to look for calcium deposits in the blood vessels supplying your heart.
For your future cardiac health, I’d like to see you add some form of aerobic exercise to your workout schedule. This could include brisk walking, running, bicycling, swimming, or a workout on an aerobic machine such as an elliptical trainer, stair-climber, or rowing machine.
