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 exam 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:
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. If you are healthy and have no symptoms of heart disease, you can say "no" to this test. And 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 don't have risk factors for heart disease or you are at high risk of heart disease. 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.
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 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.
Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.
National Heart, Lung, and Blood Institute
P.O. Box 30105
Bethesda, MD 20824-0105
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
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
Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.
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Chou R, et al. (2011). Screening asymptomatic adults with resting or exercise electrocardiography: A review of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 155(6): 375–385.
Daubert MA, et al. (2011). Computed tomography of the heart. In V Fuster et al., eds., Hurst’s The Heart, 13th ed., vol. 1, pp. 599–630. New York: McGraw-Hill.
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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.
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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.
Taylor AJ, et al. (2010). ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 – Appropriate use criteria for cardiac computed tomography. Journal of the American College of Cardiology, 56(22): 1864–1894.
U.S. Preventive Services Task Force (2009). Using nontraditional risk factors in coronary heart disease risk assessment. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspscoronaryhd.htm.
U.S. Preventive Services Task Force (2012). Screening for coronary heart disease with electrocardiography: Recommendation statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsacad.htm.
Primary Medical Reviewer
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
How this information was developed to help you make better health decisions.