Heart Tests: When Do You Need Them?

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Heart Tests: When Do You Need Them?

Topic Overview

Heart tests can be very helpful in finding out what kind of heart problem you have and what treatment you need.

These tests help doctors find out what's causing new symptoms, such as discomfort in your chest, shortness of breath, or irregular heartbeats. They can also:

  • Check your heart's electrical system.
  • Check your pacemaker or other implanted device.
  • See if your heart can handle more exercise.
  • Check how well your heart valves are working.

But they may not be helpful if your doctor doesn't have a specific reason for the test—for example, when you don't have heart disease or your treatment for heart disease isn't causing any problems.

Sometimes doctors automatically schedule routine tests because they think that's what patients expect. But experts say that routine heart tests can be a waste of time and money.

Common heart tests that experts agree aren't needed as a matter of routine include:

Why might you need a test?

Doctors order heart tests for many reasons. For example, the test can find out what's causing symptoms like unexplained chest pain, shortness of breath, or irregular heartbeats.

Heart tests can be appropriate for a healthy person. This happens when a personal history or physical examination points to risk for a heart problem. For example, an athlete may be at risk for a heart problem associated with exercise. So a test such as an exercise electrocardiogram can be done before he or she takes part in competitive sports.

Here are some other reasons why you might need certain kinds of heart tests:

Other reasons for heart tests

Heart test

What the test does

Electrocardiogram (EKG or ECG):

  • Checks your heart's electrical system and heart rhythm
  • Finds out if chest pain is caused by a heart attack or angina
  • Checks how well your pacemaker or other implanted device is working

Exercise EKG:

  • Checks for abnormal changes in your heart during exercise
  • Helps find the cause of unexplained chest pain
  • Makes sure your heart is healthy enough for physical activity, especially when you have not been physically active for a while and want to start a new exercise program
  • Sees how well you can handle exercise after you have had a heart attack or heart surgery

Echocardiogram:

  • Helps find the cause of unexplained chest pain or shortness of breath
  • Checks for signs of diseases that affect the walls and chambers of the heart
  • Finds out how well your heart is pumping blood
  • Regularly checks to see how your heart valves are working if you have a valve disease or you have an artificial valve

Coronary calcium scan:

  • Helps your doctor find out your risk for a heart attack, especially when you are at medium risk
  • Helps your doctor decide if you should change your treatment for heart disease

When should you say "no" to a test?

Heart tests help a lot when your doctor is trying to find out what's wrong, which treatment to use, or how well a certain treatment is working.

But experts say that many tests aren't needed—even for heart patients—when everything is fine and you're just having a checkup. Sometimes doctors automatically schedule routine tests because they think that's what patients expect.

Here's what experts say about common heart tests that are sometimes ordered when they're not needed:

  • Routine electrocardiogram (EKG or ECG): You may see ads telling you that "screening" EKGs are a good way to protect your health. "Screening" means having a test when you don't have any symptoms. But even if you are a heart patient, a routine EKG just isn't needed as long as you have no new symptoms and you see your doctor several times a year.
  • Exercise EKG: If you're healthy and have no symptoms of heart disease, you can say "no" to this test, often called a stress test or treadmill test. In younger people who don't have symptoms of heart disease, an exercise EKG can actually cause needless worry. This is because it can show that you have heart problems when you really don't.
  • Echo: An echocardiogram isn't recommended as a routine test if you are healthy, have no heart problems, and have a low risk for heart disease. If you have coronary artery disease, you probably don't need this test unless you have new symptoms. It's not helpful for patients with mild heart murmurs. But if you have certain heart problems, like a valve disease or heart failure, your doctor needs to check your heart regularly with this test.
  • Exercise echo: This test isn't recommended if you're healthy and have no symptoms of heart disease.
  • Calcium scan: This test isn't recommended if you already have coronary artery disease or if your risk for heart attack is low or high. In either case, the test won't tell you and your doctor anything you don't already know. But if your risk is medium, the test may tell you whether you need to take action to prevent a heart attack in the next few years. If you already have heart disease, this test won't help, because you already know your risk for heart attack is high.
    Click here to view a Decision Point. Heart Disease Risk: Should I Have a Coronary Calcium Scan?

How do you say "no" to your doctor?

The thought of saying "no" to a doctor makes a lot of people uncomfortable. But it's important to have a conversation about what the test is for. Asking a few questions is a great way to start that conversation. Try one or more of these questions:

  • "How will this test help you treat my problem?"
  • "Will this test give you information that will affect my treatment?"
  • "How often is this test wrong? Could it say that I have a problem when I really don't?"
  • "What will happen if I don't have this test?"

Health Tools Health Tools help you make wise health decisions or take action to improve your health.

Health Tools help you make wise health decisions or take action to improve your health.


Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  Heart Disease Risk: Should I Have a Coronary Calcium Scan?

Other Places To Get Help

Organizations

Canadian Cardiovascular Society
222 Queen Street
Suite 1403
Ottawa, ON  K1P 5V9
Phone: 1-877-569-3407 toll-free
(613) 569-3407
Fax: (613) 569-6574
Web Address: www.ccs.ca
 

The Canadian Cardiovascular Society works to advance the cardiovascular health and care of Canadians through leadership, research, and advocacy.


Heart and Stroke Foundation of Canada
222 Queen Street
Suite 1402
Ottawa, ON  K1P 5V9
Phone: (613) 569-4361
Fax: (613) 569-3278
Web Address: www.heartandstroke.ca
 

The Heart and Stroke Foundation of Canada works to improve the health of Canadians by preventing and reducing disability and death from heart disease and stroke through research, health promotion, and advocacy.


U.S. National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone: (301) 592-8573
Fax: (240) 629-3246
TDD: (240) 629-3255
Email: nhlbiinfo@nhlbi.nih.gov
Web Address: www.nhlbi.nih.gov
 

The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:

  • Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases).
  • Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia.
  • Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

References

Other Works Consulted

  • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
  • Gibbons RJ, et al. (2002). ACC/AHA 2002 guideline update for exercise testing: Summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation, 106(14): 1883–1892.
  • Greenland P, et al. (2007). ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain. Circulation, 115(3): 402–426.
  • Greenland P, et al. (2010). 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 56(25): e50–e103.
  • Mahmarian JJ (2004). Computed tomography of the heart. In V Fuster et al., eds., Hurst's The Heart, 11th ed., pp. 599–627. New York: McGraw-Hill.
  • Maron BJ, et al. (2007). Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 Update: A scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: Endorsed by the American College of Cardiology Foundation. Circulation, 115(12): 1643–1655.
  • U.S. Preventive Services Task Force (2009). Using Nontraditional Risk Factors in Coronary Heart Disease Risk Assessment. Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspscoronaryhd.htm.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Primary Medical Reviewer Brian D. O'Brien, MD - Internal Medicine
Specialist Medical Reviewer John A. McPherson, MD, FACC, FSCAI - Cardiology
Last Revised May 4, 2011

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