0:02 You can run a 10K, have zero symptoms,
0:05 and feel fantastic, all while a
0:07 widowmaker blockage is growing inside
0:09 you. How is [music] that possible?
0:11 Because biology doesn't care how fast
0:14 you can run. Your body is so good at
0:16 adapting that it can mask a 90%
0:18 blockage, keeping your blood flowing
0:21 perfectly right up until the second it
0:23 stops. This is why for half of all men,
0:25 the very [music] first symptom of heart
0:28 disease isn't pain, it's sudden death.
0:30 In this video, I'm going to show you why
0:32 the healthy heart fails, how your body
0:35 hides these ticking time bombs, and the
0:37 only way to actually check your heart
0:39 before it's too late. To understand why
0:42 a healthy engine fails, we have to strip
0:44 away the chest wall. When we study the
0:46 anatomy of the heart, we see a muscle
0:49 that demands more oxygen than almost any
0:51 other tissue. To get that oxygen, it
0:53 relies on a network of vessels wrapped
0:55 around it, known as the coronary
0:57 arteries. Early anatomists thought these
0:59 vessels looked like a crown, which is
1:01 where coronary comes from. But I want
1:03 you to think of them as the root system
1:06 of a massive tree. If one of those roots
1:08 is severed, the branch it supports dies
1:10 almost instantly. We have two main
1:12 players here. The right coronary artery
1:15 and the left coronary artery. The left
1:17 branches into a massive vessel called
1:20 the left anterior descending artery or
1:22 the LD. In the emergency room, we have a
1:25 grim nickname for this specific vessel,
1:27 the widow maker. The reason is simple
1:30 geometry. The L supplies blood to the
1:32 front and bottom of the left ventricle,
1:34 the heart's main pumping chamber. If you
1:36 block a small twig, you lose a leaf. If
1:38 you block the trunk, the whole tree
1:41 falls. A blockage here stops the heart's
1:43 ability to pump blood to the body,
1:45 leading to massive tissue death. But how
1:47 does a blockage form in someone who
1:50 exercises daily? To understand this, we
1:51 look at the vessel wall. A healthy
1:54 artery is flexible like a brand new
1:56 rubber garden hose. The inside lining is
1:58 called the tunica inima. In a perfect
2:01 world, this lining is smooth like
2:03 teflon. Blood cells slide right past it
2:05 without friction. But life is not
2:08 perfect. Over decades, factors like high
2:10 blood pressure, high blood sugar, and
2:13 smoking act like sandpaper on this
2:14 coating. Even the sheer mechanical
2:17 stress of high volume blood flow during
2:20 decades of intense exercise [music] can
2:22 cause microscopic scratches and tears.
2:24 This is where the trouble begins. Your
2:27 body tries to repair these scratches. It
2:30 sends LDL cholesterol to the site like
2:33 spackle to patch a hole. Then the immune
2:35 system sends white blood cells to
2:37 inspect the repair. These cells consume
2:40 the cholesterol, turn into foam cells,
2:42 and eventually harden. This hardened
2:45 mixture of cholesterol, calcium, and
2:48 cellular waste is what we call plaque.
2:51 This condition is atherosclerosis.
2:53 Now, here is the misconception that gets
2:55 people killed. Most people imagine
2:57 plaque buildup like a clog in a bathroom
3:00 sink. They think the pipe gets narrower
3:02 and narrower until one day the water
3:04 just stops. They assume they will feel
3:06 it happening, that they will get short
3:09 of breath or feel chest pain as the
3:12 opening shrinks. That is logically sound
3:14 but biologically incorrect. The human
3:16 body is incredibly adaptive. As the
3:19 plaque grows, the artery wall actually
3:21 stretches outward to accommodate it,
3:23 preserving the opening for blood flow.
3:26 This is positive remodeling. It means
3:28 you can have a massive amount of plaque,
3:31 but the tube itself remains 100% open.
3:34 You have normal blood flow and zero
3:36 symptoms. You can run a 10K and feel
3:39 fantastic because the blood is still
3:40 getting through. This is why the first
3:43 symptom of heart disease for 50% of men
3:47 and 64% of women is sudden death. They
3:49 feel fine until the very second they
3:51 [music] don't. So, what flips the
3:53 switch? What turns a silent plaque into
3:55 a fatal event? It comes down to
3:58 stability. Imagine that plaque deposit
4:00 is like a blister covered by a thin
4:03 layer of skin. This is soft plaque
4:05 filled with inflammatory gunk. If you
4:07 experience a sudden spike in blood
4:09 pressure or extreme physical exertion,
4:11 that thin skin covering the plaque can
4:14 tear. This is a plaque rupture. When
4:16 that plaque ruptures, the contents spill
4:19 into the bloodstream. The body panics.
4:22 It sees this as a massive open wound and
4:24 immediately sends platelets to clot the
4:26 blood. This is exactly what you want if
4:28 you cut your finger, but it is exactly
4:30 what you do not want inside your heart.
4:33 In a matter of minutes, that clot grows
4:35 so large that it completely seals off
4:38 the artery. It's not the slow buildup of
4:40 plaque that killed the flow. It's the
4:42 sudden rapid formation of the clot. It
4:44 acts like a cork in a wine bottle. Blood
4:47 flow hits a brick wall. This is a type
4:50 one myocardial infarction. However,
4:52 there is another scenario that often
4:54 affects endurance athletes pushing their
4:57 limits, the type 2 myocardial
4:59 infarction. Consider a 50-year-old
5:01 disciplined runner named Robert. Robert
5:03 has normal cholesterol. While running a
5:05 race, he doesn't feel crushing chest
5:08 pain. He just feels weird. His energy
5:11 drops. He feels lightaded and nauseous.
5:13 He thinks he's just dehydrated. At the
5:15 hospital, doctors find a protein called
5:17 traropponin in his blood. Think of
5:19 tronin like the liquid inside a glow
5:22 stick. As long as the plastic casing is
5:24 intact, the liquid stays inside. But if
5:27 you snap the stick, it leaks out. heart
5:29 muscle cells are full of tropponin. If
5:32 those cells die, they break open and
5:34 leak into the bloodstream. Robert is
5:35 having a heart attack, but when they
5:38 look at his arteries, they don't find a
5:41 100% blocked pipe. They find a 50%
5:43 blockage. So, how did he have a heart
5:45 attack with blood still flowing? This is
5:48 a supply and demand problem. While
5:50 sitting on a couch, a 50% blockage is
5:53 irrelevant. The hose is crimped, but
5:55 enough water gets through to water the
5:57 grass. But when Robert's heart rate
6:00 spikes to 170 beats per minute, his
6:02 heart demands a fire hose worth of
6:04 blood, the crimped artery can only
6:06 deliver a garden hose worth. The demand
6:09 exceeds the supply and the heart muscle
6:12 starts to suffocate. This is eskeeia. In
6:14 Robert's case, there was an extra factor
6:17 atrial fibrillation or AIB. Your heart
6:20 runs on an electrical grid creating a
6:23 coordinated squeeze. In Aphib, the top
6:24 chambers stop beating and start
6:27 quivering. This chaos messes up the
6:28 timing. If you combine a partial
6:30 blockage with the rapid heartbeat
6:32 [music] of Aphib, you create the perfect
6:35 storm. The heart is beating so fast it
6:36 doesn't have time to fill [music] and
6:38 the arteries can't deliver enough oxygen
6:41 to sustain the pace. This highlights the
6:44 70% threshold. Generally, you will not
6:46 feel chest pain until an artery is
6:49 roughly 70% blocked. Below [music] that,
6:52 your heart compensates. Above that, you
6:53 might feel tightness when walking
6:55 upstairs that goes away when you sit
6:58 down. We call [music] this stable anga.
7:00 It's your body's check engine light. But
7:03 remember, the majority of heart attacks
7:05 occur in people with less than 50%
7:08 blockage because soft plaques are more
7:11 prone to popping than big stable ones.
7:13 So, if you can't feel it, is there any
7:15 good news? Your heart has a secret
7:17 backup system called collateral
7:19 circulation. Think of your main arteries
7:22 as interstates. If a jam persists for
7:25 years, your heart paves side streets to
7:27 bypass the blockage. This is why a
7:29 70-year-old might survive a heart attack
7:31 that kills a 40-year-old. The older
7:34 heart had time to build those detours.
7:36 In a younger person, the rupture is
7:39 sudden. The highway shuts down and
7:41 there's no way around it. One of the
7:43 best ways to force these vessels to grow
7:47 zone 2 and HIIT training. Exercise
7:49 builds the network that [music] buys you
7:52 time. And time is the only currency that
7:56 matters. In the ER, we say time is
7:58 muscle. 20 minutes, irreversible damage
8:02 begins. 90 minutes, heart tissue turns
8:04 to scar tissue. Scar tissue doesn't
8:06 pump. To save the muscle, you have to
8:09 recognize the symptoms. Men usually get
8:11 the Hollywood heart attack, chest
8:13 pressure, and arm pain. For women, it's
8:17 insidious, extreme fatigue, shortness of
8:20 breath, or even intense acid reflux. If
8:22 you feel a sudden sense of doom, don't
8:25 ignore it. Fixing the plumbing. If the
8:28 plumbing fails, cardiologists perform a
8:30 PCI. They thread a tube through your
8:33 wrist, find the jam with dye, and
8:35 inflate a balloon to smash the plaque.
8:38 Then, they deploy a stent, a metal mesh
8:40 scaffold that holds the artery open forever.
8:42 forever.
8:44 Now, let's talk scans to find hidden
8:47 culprit, the screening strategy. But the
8:49 goal is to find the fire before the
8:51 house burns down. Standard blood work
8:54 only tells you the ingredients in your
8:55 blood. It doesn't tell you if they're
8:57 sticking to the walls. You need better
9:01 data. CAC score. A 5minut scan for
9:03 hardened calcium. A score of zero is
9:06 perfect. Over 400 is a ticking time
9:10 bomb. Next scan is CT angiogram. This
9:14 sees the soft plaque, the invisible,
9:16 unstable blisters that haven't hardened
9:19 yet. This is the ultimate early warning
9:22 system. The healthy heart attack [music]
9:25 is almost always a tragedy of ignorance.
9:27 Control your blood pressure to stop the
9:29 mechanical tearing of your arteries.
9:31 Manage your blood sugar to prevent
9:34 inflammation and keep moving. Don't
9:36 [music] guess if you're healthy. Use the
