Screening tests play an important role in diagnosing heart problems in people who have certain symptoms or heart disease risk factors. But some commonly prescribed tests probably don’t help people who are at low risk and who lack symptoms such as chest pain or shortness of breath. What’s more, they may lead to false positive results, which can trigger more invasive tests. The government-backed U.S. Preventive Services Task Force advises against routine screening for heart disease for people at low risk (risk factors include family history, older age, high blood pressure, obesity or diabetes, and smoking). Here, tests healthy people might second-guess.
1) ECG (EKG)
A readout of your heart’s electrical activity recorded by electrodes on the chest; costs about $50. An ECG (also called electrocardiogram) may help identify irregular heart rhythms, heart attacks, and other problems. No trials have looked at whether ECGs help detect the risk of disease in those without symptoms.
Whom does it help? For those with an irregular heart rate, unexplained fainting, or risk factors like a family history of heart disease, an ECG can be helpful, says cardiologist Sarah Samaan, MD, author of Best Practices for a Healthy Heart. The test is also used to screen athletes for risk of sudden death and for people with high blood pressure (to find signs of abnormal heart-muscle thickening).
A moving ultrasound of the heart, which can show how well it pumps blood and whether it has structural problems; costs between $200 and $500.
Whom does it help? An echo can help spot heart failure, atrial fibrillation, and murmurs, which are often caused by leaky or stiff valves. It can help people with high blood pressure because the test can find enlargement, weakness, or stiffness in the heart muscle. Some abnormal ECGs should prompt an echo, which can detect congenital and inheritable heart problems.
3) STRESS TEST
To spot signs of blockages, a doctor stresses the heart by putting you on a treadmill or stationary bike while doing an ECG and perhaps an echocardiogram. The test may not detect early disease (results read abnormal only if an artery is blocked 50 to 70 percent or more). Cost: $250 to $1,000.
Whom does it help? People with symptoms of blockage, such as chest pain, shortness of breath, or arm, neck, or back pain triggered by exercise, as well as sedentary people who want to start exercising.
4) CARDIAC CT SCAN
X-rays form a detailed picture of the heart. A coronary calcium scan reveals calcium deposits in heart arteries, indicating risk of heart disease. Patients with symptoms may also have dye injected to spot blockages. Cost: about $100 ($1,500 or more with dye).
Whom does it help? A coronary calcium score may determine treatment for people with a risk factor such as high cholesterol. (Diet and exercise may be enough for those with a low score; a high score may indicate a need for statins.) However, there have not been randomized trials showing that the test and resulting treatment lead to fewer heart disease deaths. Also, the dye scan may increase cancer risk slightly (due to radiation) and contribute to kidney and thyroid problems.