Rethinking Healthcare

Symptom free? 5 routine heart tests you don't need

Symptom free? 5 routine heart tests you don't need

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EKGs, ultrasounds, stress tests, CTs. If you're symptom free, there's insufficient evidence to support some common tests. They often turn up false positives, requiring invasive tests later.

This Valentine’s Day, you may be bombarded with tips on how to keep your heart healthy. And sometimes a screening or two might be recommended. But if you’re symptom free – no chest pains or shortness of breath – certain common tests might not even be all that helpful.

A test in someone who doesn't have any symptoms would likely turn up more false positives than any true positives – and these false alarms trigger more unnecessary (and possibly risky) tests.

Even in people at higher risk – such as smokers, diabetics, and obese patients – there’s insufficient evidence to support routine screening. There are no 'heart tests' that any asymptomatic man or woman should get, yet there are many that are done which they shouldn't get.

Reuters gauges the hype with a guide to common heart tests:

1. Electrocardiogram (ECG or EKG). This is a readout of your heart’s electrical activity recorded by electrodes on your chest, and it’s mostly used to study irregular heart rhythms and other problems.

Around $50. Because it's not invasive, the test itself is safe. But if the results look abnormal, a patient might end up with another test that carries more risks, like a coronary angiogram (when a catheter is threaded into the heart).

2. Carotid ultrasound. This allows doctors to see if the arteries in the neck that supply blood to the brain (the carotids) are clogged by cholesterol buildup. Plaque is a risk factor for stroke, so the test checks for blood flow to the brain.

Between $200 and $300. Routine scans produce more false alarms than true positives, and may lead to invasive imaging or carotid surgery or stenting. (Up to 3% of patients who get carotid surgery die from to the procedure, and more suffer strokes from it.)

3. Echocardiogram. This ultrasound picture of the heart allows doctors to test how well the heart pumps blood out. It helps doctors look for structural problems and diagnose heart failure and atrial fibrillation.

Between $200 and $300. Like the ultrasound scan above, it triggers false alarms that could lead to more invasive tests later.

4. Stress test. To spot signs of pumping problems, a doctor stresses the heart by putting you on a treadmill or stationary bike while doing one of the above tests. In a nuclear stress test, radioactive dye is injected into the bloodstream.

From a few hundred to $1,000. These may miss signs of heart disease and carry the usual risks of exercise, like heart attacks in rare cases.

5. Cardiac CT scan. Computed tomography scans use high-dose x-rays to get a detailed picture of the heart. In a coronary calcium scan, the doctor looks for calcium deposits in the heart's arteries.

Several hundred $$$. The radiation from these scans may increase cancer risk slightly. When dye is used, about one in 10 people develop kidney damage and some may get thyroid problems too. And as with all these tests, false alarms may lead to invasive tests.

Via Reuters.

Image by imelenchon via morgueFile

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Janet Fang

Contributing Editor

Janet Fang has written for Nature, Discover and the Point Reyes Light. She is currently a lab technician at Lamont-Doherty Earth Observatory. She holds degrees from the University of California, Berkeley and Columbia University. She is based in New York. Follow her on Twitter. Disclosure