Signs of Heart Problems You Cannot Feel: Dr. Ilan Kedan Explains

You feel fine. You train, you work, you sleep less than you should, and your heart has never given you a reason to think about it. Then a man your age does not wake up one morning, and the question lands: what are the signs of heart problems, and would you recognize them in yourself?

The uncomfortable answer from a cardiologist is that the first sign is often the last one. Heart disease builds for years without a symptom, and the medicine most of us receive is built to respond to symptoms.

In episode 40 of Live Well and Thrive, Mike Torchia sat down with Dr. Ilan Kedan, a cardiologist in Beverly Hills who runs a concierge practice and carries a handheld ultrasound to his patients’ homes and offices. What follows is what he said about why the warning signs arrive late, what screening checks, what a portable ultrasound can and cannot see, and why he thinks leanness and fitness do more than any pill.

Why the signs of heart problems arrive late

Dr. Kedan’s central point on the episode is that cardiology is reactive by design. Most patients who walk into a heart doctor’s office already carry a diagnosis, and the job from there is managing a chronic disease over time. The trouble is how they got the diagnosis.

Most of medicine and cardiology is driven by symptoms. Unfortunately that means that you wait until someone has symptoms, and sometimes the symptom is you’re dropping dead.

That is the hole in the symptom-first model. Dr. Kedan said the changes in your physiology that lead to an event can be visible on imaging before you feel anything, and that seeing them first is the whole point of his approach to preventive cardiology.

Mike brought his own evidence: friends who died of heart attacks with no warning, including one man he described as 52 who got up, said good morning, and fell forward. Afterward, Mike said, they learned he had severe blockage. Dr. Kedan’s reply was that tests to screen for heart disease exist, the same way mammograms and colonoscopies exist for cancer. Most people have simply never had them.

One sentence of general context, not from the episode: if you have chest pain, shortness of breath, or you faint, call emergency services or see a physician now, because nothing in this post is a substitute for that.

How to know if your heart is healthy without symptoms

Mike pressed Dr. Kedan on the question everyone asks: how often should a 50-year-old with no symptoms see a cardiologist? The answer surprised him. Dr. Kedan said the associations that set screening recommendations do not generally recommend a screening exam with a cardiologist at all. What they recommend is screening for the chronic conditions that drive heart disease: high blood pressure, diabetes, thyroid disease, and cholesterol, with imaging of the coronary arteries as an optional addition.

He described one such test in detail: the coronary calcium scan. In his words, it is an X-ray of the heart with no contrast and a low dose of radiation, and it looks for calcium built up in the coronary arteries. A normal result is not a warranty, he said, but it predicts a low risk of a cardiac event for 10 to 15 years. It is a test done once every five to ten years, and for some people once in a lifetime. If calcium shows up, the disease is there, and treatment begins.

The other half of his answer was about risk itself. Risk is a number, but how you act on it is a value judgment. Dr. Kedan used a one percent risk as the example: one person hears 99 percent and relaxes, another hears a one percent chance of dying and wants to be checked three times a year. How often you get looked at, he said, depends on whether you have already had an event, on your goals, on your resources, and on your comfort level. The absence of signs of heart problems, on its own, tells you very little.

What a portable ultrasound can and cannot see

The device Dr. Kedan brought to the set is a handheld wireless ultrasound probe that sends its image to a smartphone through an app. He traced its lineage on the episode. At Georgetown, where he trained in echocardiography, the machine weighed 350 pounds, was the size of a refrigerator, and recorded to VCR tape. In 2011 a pocket-sized version became commercially available, he got one of the first in Los Angeles, and he said he has scanned every patient since, a number he put at 40,000 exams.

He was direct about the limits. The coronary arteries, the vessels that block in a heart attack, are too small for the screen.

The coronary arteries are 3 to 5 millimeters in diameter, which is smaller than the resolution of the screen.

What the ultrasound shows instead is the heart muscle those arteries feed. Dr. Kedan explained that if a section of the heart squeezes abnormally with each beat, that can correlate with a blocked artery, and an old heart attack leaves a signature of scarred muscle that no longer moves. He called the tool diagnostic, and he described its role as triage: it can show whether more extensive testing is needed. He did not claim it replaces that testing.

He also described something a scanner in a separate room cannot do. With the probe in his hand and the patient in front of him, he can stand them up, have them do push-ups or jumping jacks, and watch the heart while it works. Because every image is a digital file, he can store it, send it to the patient, and compare it to the next one. He said that turns treatment into something measurable, the way you measure a 400-meter split or a bench press, and it means signs of heart problems can be tracked over years rather than discovered once.

On the radiation question Mike raised, Dr. Kedan clarified that MRI uses magnets, not radiation, though its contrast agent carries long-term unknowns and cannot be used in some patients. Ionizing radiation, the kind in X-rays, CT scans, and PET scans, can damage cells and is associated with cancer risk. Ultrasound, he said, uses none of it.

Mike’s own scare: when the image is wrong

Mike told a story on the episode that explains why this topic is personal for him. Years ago, two friends, Sly Stallone among them, ribbed him over a Saturday lunch about the red meat he ate and sent him to a cardiologist. He went in with no symptoms and, by his account, training two hours a day, six days a week. After a full battery of tests, the doctor showed his images to a room of visiting cardiologists. Every one of them agreed: quadruple bypass.

Mike wrote his will, said goodbye to his friends and his dogs, and lay on the table for an invasive angiogram with surgeons ready to open his chest if the scope confirmed it. It did not. The arteries were clear. The explanation he was given afterward: his unusually thick pectoral muscle had cast a shadow across the imaging, and the shadow had been read as blockage. He added that the run of contrast-based tests left him nauseous, without appetite, and about 30 pounds lighter.

Dr. Kedan did not defend the outcome, and he did not attack anyone. His explanation was that imaging is interpretation, not black and white. Shadows, position, and incomplete information all degrade a picture, and when a reader wants to tell a story, the blanks get filled in. You report what you can see. That, he said, is the case for being in the room with the patient instead of reading a file after they have flown home.

It is also why he scans everyone he sees. He still uses a stethoscope, he told Mike, but the probe comes out at every visit.

I trust my eyes and a visual assessment of their anatomy more than I trust my ears.

Preventive cardiology, in his words: lean and fit beats the pill

Asked what people should take from the conversation, Dr. Kedan kept returning to one answer. The most effective therapy he knows, for one person or for a whole population, is leanness and fitness.

Lean and fit is better than any pill or any powder or any supplement you could ever have.

Mike asked him about red yeast rice as an alternative to statins. Dr. Kedan’s answer was specific: professional-grade red yeast rice contains lovastatin, a naturally occurring statin drug, so it does work. But the amount of lovastatin varies from product to product, it takes a lot of red yeast rice to equal one pill, it is not for everyone, and someone who cannot tolerate statins may get the same side effects from it because the statin is in there. That is a description of what the supplement is, not a recommendation to take it. That decision belongs with your physician.

He also explained what changed in his own practice. For 17 and a half years he was an employed physician in an insurance-based system, where volume pays and volume means less time per patient. Now his practice is fully concierge. A first visit, he said, runs a minimum of an hour and covers a head-to-toe scan, and if it takes longer, it takes longer.

How this fits the Operation Fitness method

Mike’s habits, described on the same episode, line up with what Dr. Kedan recommended. At 68 at the time of recording, Mike gets comprehensive blood work every four months, asks for his pulse and blood pressure at every checkup, and tracks all of it. His reasoning was plain: if you skip the checkups, one day you may not wake up. Dr. Kedan’s reply became the line of the episode.

You’re fine until you’re not fine.

That is why every Operation Fitness program starts with testing. Mike’s rule is that you cannot get onto a longevity program until you have addressed your health issues first, and a heart that has never been looked at is an unaddressed issue. Waiting for signs of heart problems is not a plan. The programs are designed by Mike and delivered by his team, and the first step is the same for everyone: tested, not guessed.

Where to go from here

Watch the full conversation with Dr. Ilan Kedan on YouTube: Ep. 40, Heart Health with Portable Ultrasound.

See how testing comes first in every Operation Fitness program at /programs.

If you want a conversation about where to start, request a consultation.