A Tennessee-based cardiologist has sparked widespread discussion after explaining that most heart attacks do not come from the large, obvious blockages people usually fear. In an Instagram post shared on November 29, Dr. Dmitry Yaranov clarified that the biggest danger often lies in tiny, unstable plaques hidden inside artery walls—plaques that rarely show symptoms and may not appear even on routine stress tests.
Dr. Yaranov explained that a stress test only measures how well blood flows through the heart during exertion, much like observing traffic movement. It cannot reveal what is happening inside the arterial walls, where heart attacks typically begin. He compared the difference by saying that while a stress test looks at traffic flow, a CT Coronary Angiogram examines the road itself, spotting cracks, weak areas, or early signs of disease.
Many assume that severe blockages are responsible for most heart attacks, but Dr. Yaranov noted that the majority are caused by small, soft, inflamed plaques that do not significantly obstruct blood flow. Because they remain undetected, they can rupture suddenly, triggering a heart attack without any advance symptoms. This is why, he said, cardiology is shifting from asking whether there is a blockage to asking whether a person has underlying coronary artery disease at all. Even someone who “aces” a stress test may still be carrying unstable plaque.
For those with symptoms, diabetes, family history, or other risk factors, Dr. Yaranov recommends a CT Coronary Angiogram as a more accurate assessment tool. The scan offers a detailed view of artery walls, revealing plaque buildup and early disease much more effectively than conventional stress testing. He emphasised that the test shows “the actual disease, not a shadow of it,” underscoring the importance of early detection in preventing unexpected cardiac events.
Heart disease remains one of the leading causes of death, and specialists continue to stress that normal test results are not a guarantee of clean arteries. As conversations around silent plaque and more precise screening grow, experts urge at-risk individuals to seek proactive evaluation rather than relying solely on traditional stress tests.
