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:

• EKGs (electrocardiograms).
• Exercise treadmill tests, also called stress tests or exercise EKGs.
• Echos (echocardiograms).
• Coronary calcium scans.

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.

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

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. And experts say that you don't need a routine EKG when you're getting ready to compete in sports, as long as you are healthy and don't have heart problems.
• 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.¹
• Echo: An echocardiogram isn't recommended if you are healthy, have no heart problems, and have a low risk for heart disease. This is not a test you need if you want to compete in sports, as long as you are a normal, healthy person. If you have coronary artery disease (CAD), 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.²
• 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.

  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:

• "This test probably costs a lot, and I'm trying to save money. Do you think the cost is worth it for me?"
• "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.

	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?

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References

Citations

1. 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.
2. Douglas PS, et al. (2008). ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 Appropriateness Criteria for Stress Echocardiography: A Report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, American Society of Echocardiography, American College of Emergency Physicians, American Heart Association, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance: endorsed by the Heart Rhythm Society and the Society of Critical Care Medicine. Circulation, 117(11): 1478–1497. Available online: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.189097.

Other Works Consulted

• Budoff MJ, et al. (2008). Computed tomography of the heart. In V Fuster et al., eds., Hurst's The Heart, 12th ed., pp. 577–606. New York: McGraw-Hill Medical.
• 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.
• Greenland P, et al. (2004). Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA, 291(2): 210–215.
• 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.
• 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.ahrq.gov/clinic/uspstf09/coronaryhdrs.htm.

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