You Can Feel Fine and Still Have Heart Disease: South Jersey Radiologist Explains How Imaging Can Find Hidden Trouble

Dr. Thomas Reilly says coronary disease can develop silently for years — while new 2026 heart-health guidelines put greater emphasis on identifying individual risk before a heart attack occurs

SOUTH JERSEY — You exercise. You don't have chest pain. You don't get unusually short of breath. You feel perfectly healthy.

That doesn't necessarily mean your coronary arteries are healthy.

That was one of the central messages from Dr. Thomas Reilly, a board-certified radiologist with New Jersey Imaging Network, during an appearance Tuesday on The Lorry Young Show on News Talk 1400 and 92.3 WOND.

“You can feel fine and your heart's not fine,” Reilly said. “This is why we'll get into some of the things we're going to talk about, about screening and being proactive and taking care of your own heart health.”

The conversation was particularly timely. It came one day after World Heart Day and just months after the American College of Cardiology and American Heart Association issued significantly updated guidelines for assessing and managing cardiovascular risk.

For South Jersey residents, Reilly's message is a practical one: Know your risk factors, don't assume the absence of symptoms means the absence of disease, and talk with your doctor about whether additional testing is appropriate for you.

Heart Disease Can Develop for Decades

Reilly said a heart attack is often the culmination of a process that has been developing quietly for years.

“Most people hear heart disease, right, they think about someone having a heart attack,” Reilly said. “But that heart attack is really the end result of a disease process that begins in all of us and develops for years.”

That process is atherosclerosis — the buildup of plaque within arteries.

“This plaque buildup starts in childhood and progresses for decades,” Reilly said.

Risk isn't the same for everyone.

Age, sex, family history and certain genetic factors cannot be changed. But Reilly said there is also a substantial list of risk factors people can do something about, including smoking, high blood pressure, elevated cholesterol, diabetes, obesity, physical inactivity, poor diet, excessive alcohol consumption and poor sleep.

“It's so important because this disease process is really a slow developing process where we can slow or stop the progression based on having our modifiable risk factors and medications and whatnot in appropriate levels,” Reilly said.

That emphasis on earlier prevention is consistent with the new 2026 ACC/AHA dyslipidemia guidelines, which place greater emphasis on assessing cardiovascular risk earlier and reducing long-term exposure to plaque-causing lipids.

A New Recommendation: One Blood Test Many People Have Never Had

One of Reilly's recommendations may be unfamiliar even to people who routinely have their cholesterol checked.

It's called lipoprotein(a), or Lp(a).

Reilly described Lp(a) as a genetically determined lipoprotein that isn't ordinarily included in a standard cholesterol panel.

“It's worth talking to your doctor about because the current guidelines from the American Heart Association recommend at least once in adulthood that you should have this lab checked,” Reilly said.

That statement is supported by the new national guidance.

The 2026 ACC/AHA guidelines recommend measuring Lp(a) at least once in adulthood. The level is largely determined by genetics and generally remains relatively stable over a person's lifetime. Elevated Lp(a) is considered an additional risk factor for atherosclerotic cardiovascular disease.

It's one of the more significant changes in the new guidelines and provides another way for physicians to identify risk that might not be obvious from an ordinary cholesterol test.

Beyond a Risk Calculator

The new guidelines also recommend using the American Heart Association's PREVENT equations for primary-prevention risk assessment in adults ages 30 to 79 who meet the applicable criteria.

The calculator considers information such as age, cholesterol and blood pressure to estimate a person's longer-term cardiovascular risk.

Reilly discussed PREVENT during the WOND interview but said population-based risk calculations can't tell physicians everything about a particular patient.

“You could have two 50-year-old men that have a similar calculated cardiovascular risk in one of these models like PREVENT,” Reilly said. “But one of those men could have no coronary artery disease based on the probability, while the other could have substantial plaque and be on the verge of a heart attack, and you just don't know.”

That's where Reilly said imaging can sometimes provide additional information.

“Many conditions can be detected earlier and therefore managed more aggressively and earlier and effectively if you have some of these advanced imaging studies,” he said.

Imaging isn't necessary or appropriate for everyone, however. The type of testing — if any — depends on a person's symptoms, age, medical history and overall cardiovascular risk and should be determined with a medical professional.

What Is a Coronary Calcium Score?

One of the tests Reilly discussed is a CT coronary artery calcium scan, commonly called a calcium score.

It's a relatively quick CT examination performed without intravenous contrast. The scan detects calcium within plaque in the coronary arteries.

“We then use special software to look at the amount of calcification in those coronary arteries,” Reilly said. “And it produces what's known as an Agatston score.”

A score of zero means no calcified coronary plaque was detected on the scan. Higher numbers indicate increasing amounts of calcified plaque.

The 2026 ACC/AHA guidelines expanded the role of calcium scoring in certain patients when physicians remain uncertain about cardiovascular risk and treatment decisions. Current guidance says it can improve risk assessment in men at least 40 and women at least 45 when appropriately selected.

But Reilly stressed an important limitation.

A calcium score is not a percentage showing how blocked an artery is.

“You can have a calcium score of 400,” Reilly said. “It doesn't mean that you have a 400 percent or a 40 percent blockage.”

And calcium scoring doesn't detect all plaque.

“You don't know if this calcified plaque is actually causing a blockage, also known as a stenosis,” Reilly said. “And you also do not know if there's non-calcified plaque.”

Two Healthy Doctors — And a Surprising Discovery

Perhaps the most striking part of Reilly's interview involved two actual physician-patients he said were seen at a New Jersey Imaging Network office.

Both were in their 50s. Both were healthy and without symptoms. Both wanted a better understanding of their cardiovascular risk.

The first physician underwent a calcium scan and received a score around 400.

“He's not happy about it,” Reilly said.

The physician subsequently underwent a coronary CT angiogram, or CCTA, a more detailed examination.

Despite his high calcium score, Reilly said the CTA showed only several mild blockages that did not require intervention.

Then came the second physician.

His calcium score was only 10.

“He's pretty happy,” Reilly recalled.

But because he was particularly health-conscious, the physician proceeded with a coronary CTA anyway.

The result was dramatically different.

“Physician B's coronary CTA shows a significant-sized non-calcified plaque, which is unable to be seen on the calcium score,” Reilly said. “And it's resulting in a stenosis of a high enough degree that he actually went on to a cardiologist and had a stent placed.”

Reilly called it a powerful example of what the more detailed examination can reveal.

The example shouldn't be interpreted to mean that everyone with a low calcium score needs a coronary CTA. Rather, it illustrates the different information provided by the two tests and why decisions about cardiac imaging need to be individualized.

What Does a Coronary CTA See?

Unlike a calcium scan, a coronary CTA uses intravenous contrast and specialized CT imaging to look directly at the coronary arteries while accounting for the heart's movement.

“Those coronary arteries are now completely filled in with contrast,” Reilly explained. “So anything inside the lumen of those arteries, like plaque, we will be able to see it, and we can actually see it narrowing the coronary arteries.”

That allows radiologists to evaluate the degree of narrowing in individual coronary arteries.

Reilly also compared coronary CTA with nuclear stress testing. A stress test examines the heart for evidence of impaired blood flow under stress, while CCTA provides an anatomical look at the coronary arteries themselves.

Both approaches remain part of modern cardiac evaluation. Which test is appropriate depends on the patient and the clinical circumstances.

Artificial Intelligence Is Entering the Picture

The technology is evolving further.

Reilly said artificial-intelligence software can now analyze coronary CTA examinations and quantify both calcified and non-calcified plaque.

“They're able to quantify in cubic millimeters the amount of both calcified plaque and non-calcified plaque and give us back a detailed report with actual numbers that your doctor can look at,” Reilly said.

That potentially gives physicians another way to monitor changes in plaque over time.

“We can then repeat the study in a couple of years and see, based on your lifestyle modifications and your medications and just the progression, has the volume of your plaque increased?” Reilly said.

A Message for South Jersey

The issue has particular relevance locally.

Heart disease has long ranked among the major causes of death in New Jersey, including Atlantic and Cape May counties, according to New Jersey Department of Health mortality data. Because county-level figures can lag behind the calendar year, South Jersey NewsBeat is not using older county totals to characterize the current 2026 situation.

But residents don't have to travel far to find the types of testing Reilly discussed.

Reilly practices with New Jersey Imaging Network, which operates South Jersey locations, including Haddon Heights and Washington Township. During the interview, Reilly said the practice performs coronary calcium scoring and other cardiac imaging.

The broader point, however, isn't that everyone should schedule an advanced cardiac scan.

It's that cardiovascular risk can exist before someone feels sick.

Reilly recommended starting with the basics: know your blood pressure, know your cholesterol, address risk factors such as smoking and discuss your individual cardiovascular risk with your physician. The newer national guidelines add another conversation to that list: whether you've ever had your Lp(a) checked.

“You could feel fine, but it doesn't mean that your heart's fine,” Reilly said near the end of the interview. “It's important to be proactive in your own health.”

For some patients, that may mean lifestyle changes or medication. For others, their physician may determine additional testing is warranted.

The key, Reilly said, is finding trouble before a heart attack or heart failure becomes the first warning.

“We want to treat this coronary artery disease, lower your risk before you get to a point of heart attacks and heart failure,” he said.

Dr. Thomas Reilly spoke with Lorry Young on The Lorry Young Show on News Talk 1400 and 92.3 WOND. The Lorry Young Show airs Monday through Friday from 1 to 2 p.m.