Testing after heart procedures

When you need a nuclear stress test—and when you don’t

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If you’ve had heart bypass surgery or a stent procedure to open a blocked artery, a test that takes pictures of your heart while it is being stressed can help show how well the treatment is working. But unless you are experiencing symptoms of heart disease, this test usually isn’t helpful in the first few years after either procedure. Here’s why:

The test isn’t always necessary.

Chest pain and other heart-related symptoms can return even though you’ve had bypass surgery or had a stent inserted to treat the problem. If that happens, a nuclear stress test—which makes the heart work harder and produces images using a small dose of a radioactive substance—can show if the treated area has become blocked again, or if a new blockage has formed. The test can also help you and your doctor decide if additional medication or another heart procedure is needed. But many people have the test every year after their procedure to see if their heart problems are coming back, even if they don’t have symptoms. Those tests rarely find problems that require further treatment.

The test can pose risks.

The test is usually very safe and can be done with little radiation. But in people who don’t have symptoms, it may produce false-positive results that can cause anxiety and trigger a follow-up test such as coronary angiography (cardiac catheterization), which 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. The test can also lead to an additional heart procedure that has risks but is not proven to prolong life or reduce the risk of a heart attack in people who don’t have symptoms.

Testing can be expensive.

A nuclear stress test costs more than $600, according to Healthcare Blue Book. In addition, false-positive results can lead to coronary angiography that costs more than $1,000, and unnecessary surgery costing more than $10,000. So the test should only be used when it will help you and your doctor manage your disease.

When is the test warranted after a heart procedure?

A nuclear stress test should often be ordered if symptoms—such as chest pain, shortness of breath, fatigue, or difficulty climbing stairs—come back or get worse. It can also be reasonable to have the test five years after bypass surgery or more than two years after a stent procedure, or if you have high-risk factors such as diabetes, very aggressive heart disease, or blockages that weren’t treated during the heart procedure.

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