EKGs and exercise stress tests

When you need them for heart disease—and when you don't

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If you have chest pain or other symptoms of heart disease, an electrocardiogram (EKG) or exercise stress test can be lifesaving. The same is true if you have a history of heart disease or are at very high risk for it. But in other cases, you should think twice. Here’s why:

The tests usually aren’t necessary for people without symptoms.

With an EKG, electrodes attached to your chest record your heart’s electrical activity. When an EKG is done as you walk or jog on a treadmill, it’s called an exercise stress test. If you have symptoms of heart disease or are at high risk for it, both can help determine your chances of having a heart attack and help you and your doctor decide how to treat the problem.

But the tests are less accurate for lower-risk people and often have misleading results. Yet many people without symptoms of heart disease get the tests as part of their routine checkup. For example, in a 2010 Consumer Reports survey of nearly 1,200 people between the ages of 40 and 60 with no history of heart disease or heart-disease symptoms, 39 percent said they had undergone an EKG during the previous five years and 12 percent said they had an exercise stress test.

They can pose risks.

EKGs and exercise stress tests won’t harm you directly. But both can produce inaccurate results that trigger follow-up tests that can pose risks. Those include CT angiography, which can expose you to a radiation dose equal to 600 to 800 chest X-rays, and standard coronary angiography, an invasive procedure that exposes you to further radiation. The risk posed by any one source is uncertain, but the effect of radiation is cumulative, so it’s best to avoid exposure when you can. Inappropriate testing can also lead to overtreatment with drugs or even angioplasty, a procedure that can ease the symptoms of heart disease but for many people is no better than lifestyle changes and medication—and triggers heart attacks in 1 to 2 percent of patients.

They can be a waste of money.

An EKG typically costs about $50 and an exercise stress test about $200 to $300, according to HealthcareBlueBook.com. But any money spent on unnecessary tests is money wasted. And subsequent interventions prompted by unneeded tests can add thousands to the tab.

So when are the tests warranted?

An EKG and exercise stress test are often necessary if you have chest pain, shortness of breath, an irregular heartbeat or palpitations, or other symptoms of heart disease. They can also make sense for people with diabetes or other risk factors who are just starting to exercise.

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Published by Consumer Reports © 2012 Consumers Union of U.S., Inc., 101 Truman Ave., Yonkers, NY 10703-1057. Developed in cooperation with AAFP. Portions are from AAFP's “Five Things Physicians and Patients Should Question” list. © 2012 AAFP. This list is based on the “The ‘Top 5’ Lists in Primary Care: Meeting the Responsibility of Professionalism,” The Good Stewardship Working Group, Arch Intern Med. 2011;171:1385-1390. “ ‘Top 5’ Lists in Primary Care” were first published as part of the Less Is More™ series in the Archives of Internal Medicine. © 2011 American Medical Association.

04/2012