Warning Signs of Heart Trouble during Exercise

Exercise is safe for most people and is actively encouraged. In the short term, it can improve your mood and energy levels. In the long run, it has been proven to improve the outcomes of chronic diseases including heart health.

In general, 30 minutes of a moderate level of exercise (eg. brisk walking, recreational swimming or cycling) each day is encouraged. This holds true for people of all ages, and studies have demonstrated a reduction of cardiac risk in people up to 80 years old who exercise.

So, people of all ages can benefit from exercise, and its risks are extremely small. But sometimes, heart problems can surface during a workout. How are cardiac problems detected, and how can we avoid them?

If you're concerned an exercise regimen may affect your health, always speak to a doctor.

Cardiopulmonary exercise testing

It's normal for physical activity to make you feel fatigued, especially if you are not used to it.

There are many physiological benefits to exercise, such as improvements in muscular function and strength (physical fitness) and improvement in the body's ability to take in and use oxygen (maximal oxygen consumption or aerobic capacity). As the ability to transport and use oxygen improves, regular daily activities can be performed with less fatigue. This is particularly important for people with cardiovascular disease, whose exercise capacity is typically lower than that of healthy individuals.

A cardiopulmonary exercise test simultaneously evaluates the heart, lung and circulatory function response to exercise. This provides important information on the efficiency of oxygen uptake and consumption. The test is suitable for:

• Healthy individuals wishing to assess their fitness prior to training, in order to help meet personal fitness goals or weight loss targets
• Athletes at all levels needing expert guidance to measure and adjust the balance of training programmes

Cardiac symptoms during exercise:  When to be concerned?

The risks of exercise are extremely small. Precautions should be taken if one has suffered a previous heart attack or have risk factors for heart disease. Medical attention should be urgently sought if there are warning signs of heart trouble. Ignoring these symptoms can have adverse consequences.

Warning signs include:

• Chest discomfort
• Shortness of breath – a feeling of unusual breathlessness with or without chest discomfort may be a precursor to a heart attack
• Dizziness or lightheadedness
• Heart rhythm abnormalities – eg. skipping heartbeats, palpitations
• Discomfort in other areas of the body – eg. pain or pressure in the arms, back, neck, jaw, or stomach can be a manifestation of heart disease

Age-related risk factors

In young people (below 40 years old), the common causes of cardiac symptoms are related to structural abnormalities in the heart. Conditions causing abnormal thickness in the wall of the heart muscle (cardiomyopathy) or inherited electrical disturbances should be excluded from consideration, since they can be linked to an increased risk of sudden fatality.

In later age, and especially in the presence of risk factors, coronary artery disease due to cholesterol-rich plaque build-up is more likely to be the cause of exercise-related symptoms. These important causes can be ruled out using a series of tests including an electrocardiogram, exercise treadmill test, and echocardiogram. Cardiac CT or magnetic resonance imaging (MRI) can check for structural abnormalities. If the symptoms are indeed attributed to a cardiac cause, the doctor can manage the condition with treatments and advise on thresholds of exercise capacity.

People with a history of heart disease or have multiple risk factors should consult their cardiologist before commencing any vigorous exercise training programme. Supervised exercise-based cardiac rehabilitation programmes are recommended for patients after cardiac events. These are proven to improve confidence and long term recovery, and reduce the risk of relapse.

To speak to a cardiologist or arrange for a heart screening, make an appointment.