Heart tests before surgery
When you need an imaging test—and when you don’tDownload PDF
If you’re scheduled for surgery, a test that takes pictures of your heart can sometimes help to identify medical problems that might call for a delay or change in your operation. But if your surgery isn’t related to the heart and you don’t have heart-related symptoms or risk factors, the test may not be helpful. Here’s why:
Pre-surgery tests aren’t always necessary.
A pre-operative imaging test such as a CT scan or cardiac stress test—using sound waves (ultrasound or echocardiography) or a small dose of a radioactive substance (nuclear cardiology)—can show whether you’re at risk of having a serious heart problem, such as a heart attack, during or soon after surgery. The results may lead to postponing surgery until the problem is treated, choosing a less invasive procedure, or getting special care before, during, or after your operation. But those tests aren’t useful for most people undergoing minor procedures such as eye surgery or breast biopsy. That’s because the risk of heart complications from such operations is so low that it’s hard to do anything differently to lower it further. In fact, even major surgery is safe for most healthy people who feel well and are moderately active. All they usually need is a medical history and physical exam.
The tests can pose risks.
These preoperative tests are usually very safe and can be done with little or no radiation. But if you’re unlikely to have a heart problem, they may produce false-positive results that could prompt anxiety, additional tests, and delay of surgery. For instance, they might be followed up with coronary angiography (cardiac catheterization), a test that uses dye and X-rays. While the risk from any one test is uncertain, risks are cumulative, so it’s best to avoid unnecessary radiation exposure or invasive procedures.
Testing can be expensive.
An imaging stress test or cardiac CT costs between $500 and $2,000. If abnormal results lead to coronary angiography, it can add more than $1,000. So the tests should be used only when the results would change how you’re treated.
When are the tests needed before surgery?
An imaging test may be ordered even for low-risk surgery if you have a severe heart condition or you’re experiencing symptoms that could be heart-related, such as chest pain, breathing difficulty, or a loss of stamina. They may also be considered prior to intermediate-risk surgery (such as knee or hip replacement) or high-risk surgery (such as a bypass operation for leg artery blockages) in people who have risk factors—including diabetes, kidney disease, or a history of coronary artery disease, heart failure or stroke—and can’t walk a short distance or climb stairs without experiencing heart-related symptoms.
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Consumer Reports' Advice
How should you prepare for surgery?
Your doctor or the hospital’s pre-operative evaluation team will examine you a week or two prior to surgery. Make sure they provide a specific reason for any pre-operative test. Bring a list of all the drugs and supplements you take. Also mention any new symptoms that could be warning signs of heart disease. And consider taking these steps to make surgery safer:
- Quit smoking, at least temporarily. The earlier you quit, the less likely you are to experience complications. It’s especially important not to smoke on the day of your operation. If you need help, ask for a nicotine patch.
- Consider banking your blood. That eliminates the slight risk of infection and reaction if you need a transfusion.
- Ask about OTC pain relievers. Ibuprofen (Advil, Motrin and generic) and naproxen (Aleve and generic) can cause excess surgical bleeding, so stick with acetaminophen (Tylenol and generic). Ask your doctor if and when you should stop aspirin or other blood thinner.
- Line up post-surgery help. Have someone drive you to and from the hospital and stay overnight if necessary. Find out about nursing or rehab care, too.
- Pack a bag. Don’t bring valuables, but do bring insurance cards, containers for dentures, contact lenses and eyeglasses, and a few comforting items such as a music player, photos, and a robe or pillow.