Testing after heart procedures
When you need a nuclear stress test—and when you don’tDownload PDF
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.
Using This InformationThis information is provided for you to use in discussions with your health care provider. The content is for educational use only and is not a substitute for professional medical advice, diagnosis, or treatment. Unfortunately, we cannot help you with individual medical questions. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard, avoid or delay in obtaining medical advice from your doctor or other qualified health care provider because of something you have read in this report. Use of this report is at your own risk. Consumer Reports, American Society of Nuclear Cardiology (ASNC), ABIM Foundation, and their distributors are not liable for any loss, injury, or other damages related to your use of this report. The report is intended solely for consumers’ personal, noncommercial use and may not be altered or modified in any way or used in advertising, promotion, or for any other commercial purpose. Special permission is granted to organizations participating in the Consumer Reports consumer health communication program to disseminate free copies of this report in print or digital (PDF) formats to individual members and employees. Published by Consumer Reports © 2012 Consumers Union of U.S., Inc., 101 Truman Ave., Yonkers, NY 10703-1057. Used with American Society of Nuclear Cardiology for Choosing Wisely, a project of the ABIM Foundation. Portions of this report are derived from ASNC’s “Five Things Physicians and Patients Should Question” list. © 2012 American Society of Nuclear Cardiology.
Consumer Reports' Advice
How to recover after a heart procedure
A cardiac rehabilitation program can help strengthen your heart, reduce the risk of a future heart attack, and speed your recovery. You’ll need your doctor’s approval to participate, so let your doctor or nurse know that you’re interested. Look for a program that:
- Is accredited. Look for approval from the American Association of Cardiovascular and Pulmonary Rehabilitation.
- Is close to home. If there’s no facility nearby, ask if you can arrange less frequent visits or home visits.
- Does a thorough evaluation. That includes a review of your diet and exercise habits, readings of your blood pressure, blood sugar, and cholesterol levels, and a stress test before you start a supervised exercise program.
- Keeps tabs on your medications. Your rehab doctor should periodically review them and work with your cardiologist to adjust them when necessary.
- Counsels you on nutrition. A dietitian or nutritionist should develop a plan that’s based on your risk factors, such as high blood pressure or diabetes, and that accommodates your tastes and preferences.
- Assigns a case manager. He or she should coordinate your care and keep your cardiologist informed of your progress.