Heart Tests: When Do You Need Them?

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Topic Overview

Heart tests can help your doctor find out if you are at risk for a heart problem, if you have a heart problem, and what treatment you need.

There are many heart tests. Most are noninvasive, which means that your doctor does not insert a device into your body for the test. Many of the tests provide still or moving images of your heart and blood vessels.

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

  • 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.
  • Look for problems with the structure of your heart.

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.

You can help decide if a test is right for you. Talk with your doctor to make that decision.

Noninvasive tests

Noninvasive tests do not require a doctor to insert a device into your body. You may need an injection of a medicine during the test. Many of these tests are imaging tests that provide still or moving pictures of your heart.

  • Cardiac blood pool scan
    • Makes pictures of the heart
    • Shows how well your heart is pumping blood to your body
    • Checks the size of heart chambers
    • Checks for problems with blood flow or structure of the heart
  • Cardiac CT scan
    • Makes pictures of the heart and blood vessels
    • Checks for coronary artery disease
    • Checks for problems with blood vessels and heart valves
    • Checks for problems with the structure of the heart
  • Cardiac MRI scan
    • Makes still pictures and moving pictures of the heart
    • Checks the pumping action of the heart
    • Checks for problems with the structure of the heart
  • Cardiac perfusion scan
    • Makes pictures of blood flow to the heart muscle
    • Checks for coronary artery disease
    • Checks for damage caused by a heart attack
  • Coronary calcium scan
    • Makes pictures of the walls of coronary arteries
    • Checks for calcium in coronary arteries
    • Helps your doctor find out your risk for a heart attack, especially when you are at medium risk
  • Echocardiogram
    • Makes moving pictures of the heart
    • Helps find the cause of unexplained chest pain or pressure, or shortness of breath
    • Checks for signs of diseases that affect the walls and chambers of the heart
    • Checks how well your heart is pumping blood
    • Checks how well valves are working
  • Electrocardiogram (EKG or ECG)
    • Checks your heart's electrical system and heart rhythm
    • Finds out if chest pain or pressure 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 or pressure
    • Makes sure your heart is healthy enough for physical activity

Invasive tests

Invasive tests require a doctor to insert a tube called a catheter into blood vessels in your body.

  • Cardiac catheterization
    • Makes moving pictures of blood flow in the heart
    • Checks blood flow and blood pressure in the chambers of the heart
    • Checks how well the heart valves work
    • Checks for problems in the structure of the heart
    • Checks how well the walls of the heart move
  • Coronary angiogram
    • Makes moving pictures of blood flow in coronary arteries
    • Checks for narrowing or blockages
    • Checks blood flow

Questions to ask your doctor

Before you have a test, you can ask your doctor questions so that you can decide together if a test is right for you.

Questions that you might ask your doctor include:

  • "Why am I going to have this test?"
  • "Are there other tests that will give the same information? Do I have a choice of which test to have? Do I need more than one of these tests?"
  • "Will this test help you treat my problem? Will the test results change how I am being treated now?"
  • "How often is this test wrong? Could it say that I have a problem when I really don't?"
  • "What are the risks of this test?"
  • "What will happen if I don't have this test?"
  • "How much does this test cost?"

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 sometimes heart tests aren't needed-even for heart patients. It may be okay to not have a test when everything is fine and you're just having a checkup. A test 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 does not need to change.

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.
  • Imaging tests:An imaging test, such as a cardiac perfusion scan, is not recommended before a surgery that is not being done on your heart and has a low risk of problems. An example is a cataract surgery.
  • 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.

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References

Other Works Consulted

  • Cheitlin MD, et al. (2003). ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: Summary article: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation, 108(9): 1146-1162. Available online: http://circ.ahajournals.org/cgi/reprint/108/9/1146.
  • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
  • 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.
  • 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.
  • 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. 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.

Credits

ByHealthwise Staff

Primary Medical Reviewer Rakesh K. Pai, MD - Cardiology, Electrophysiology

E. Gregory Thompson, MD - Internal Medicine

Martin J. Gabica, MD - Family Medicine

Adam Husney, MD - Family Medicine

Specialist Medical Reviewer Robert A. Kloner, MD, PhD - Cardiology

Current as ofDecember 6, 2017

Current as of: December 6, 2017

Author: Healthwise Staff

Medical Review: Rakesh K. Pai, MD - Cardiology, Electrophysiology & E. Gregory Thompson, MD - Internal Medicine & Martin J. Gabica, MD - Family Medicine & Adam Husney, MD - Family Medicine & Robert A. Kloner, MD, PhD - Cardiology