Young, fit, and work out daily? You are still at risk of a heart attack, warns cardiologist

In a detailed post shared on X, cardiologist Dr. Shailesh Singh addressed a startling reality—that even individuals who appear to be in top physical shape, working out regularly and maintaining athlete-level fitness, may still fall victim to sudden cardiac arrest.

He illustrated this with the example of a seemingly healthy 33-year-old who trains six days a week, reports no symptoms, and has a resting heart rate typical of a trained athlete. Yet beneath this picture of health lies an unseen danger—an abnormally thickened heart wall, a condition known as Hypertrophic Cardiomyopathy (HCM), where the ventricular septum can measure up to 18 mm instead of the normal 12 mm.

According to Dr. Singh, such individuals often remain unaware that their heart muscle is structurally different. In many cases, there’s an underlying genetic predisposition—perhaps a relative who died suddenly at a young age during physical activity, dismissed at the time as a tragic fluke. Unfortunately, these deaths often have a genetic cause that goes unnoticed.

What makes this especially dangerous, Dr. Singh explained, is that routine health screenings typically fail to detect these silent conditions. Physical examinations, normal blood pressure readings, and even standard ECGs may appear fine. In fact, only about 50–70% of hypertrophic cardiomyopathy cases are identified through ECGs.

The gold-standard diagnostic tool—cardiac MRI—provides the clearest picture, but it is neither cost-effective nor practical to perform such scans for every healthy-looking gymgoer. Consequently, a large number of people at risk remain unscreened, and these conditions stay hidden until they trigger a sudden, fatal event.
Dr. Singh pointed out that up to 30% of HCM cases first present as sudden death, often during intense exertion.

Another cardiac disorder, Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), is even more elusive because its fibrofatty changes occur in the right ventricle, which is difficult to visualize with standard echocardiography.

To minimize these risks, he urged individuals to be proactive about family medical history, especially if sudden deaths have occurred among relatives below 50. Such people should undergo preventive tests, including ECG, echocardiogram, or cardiac MRI, before engaging in high-intensity workouts. Symptoms like chest pressure, prolonged palpitations, or fainting spells during or after exercise must never be ignored—they signal potential electrical instability within the heart.

As Mayo Clinic reports, HCM causes the heart muscle to thicken, making it harder for the organ to pump blood efficiently. Though many people remain symptom-free, a few experience shortness of breath, chest discomfort, dizziness, or irregular heartbeats, which can sometimes escalate into life-threatening situations.
Dr. Singh’s message underscores a crucial truth—fitness alone isn’t immunity. True health requires awareness, vigilance, and timely screening, especially for those with hereditary risks or unexplained cardiac symptoms.