Heart tests before surgery

When you need an imaging test—and when you don’t

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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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