Stress Tests for Chest Pain

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

If you have chest pain that suggests you might have heart disease, a test that stresses the heart can help you and your doctor decide how to treat the problem. In some cases, an imaging test that takes pictures of your heart while it is stressed can provide more information. But if you’re at low risk for having a heart problem, even if you have symptoms, you usually don’t need the imaging test. Here’s why.

Some chest pain isn’t from heart disease.

A cardiac stress test makes the heart work hard so your doctor can see if it responds normally. Adding imaging—with sound waves (ultra­sound or echocardiography) or a small dose of a radioactive substance (nuclear cardiology)—will make can help determine the extent and severity of heart disease. But chest pain can have many possible causes besides heart disease, such as in­digestion, anxiety, or muscle injury. If the doc­tor’s initial evaluation shows that you probably don’t have a heart problem, you may not need a stress test at all. And if you do, a simple exercise stress test—in which you walk or jog on a tread­mill while connected to an electrocardiogram (ECG)—should often be the first choice because it has little risk and is inexpensive, easy to per­form, and usually accurate in low-risk people.

They can pose risks.

Imaging stress tests are usually safe and can be done with little or no radiation. But for people at low risk, such tests may produce false-positive results, which can trigger unnecessary follow-up tests that expose you to additional radiation. Inappropriate testing can also lead to unneces­sary treatment.

They can be expensive.

An imaging stress test costs between $500 and $2,000, compared with $200 to $300 for an ECG treadmill test. Since imaging tests can provide more information, they may be worth it. But money spent on inappropriate tests is money wasted, especially when they lead to more un­necessary tests and further expense. So the tests should be used only when they will help you and your doctor manage your disease.

When do people with chest pain need imaging tests?

An imaging stress test should often be ordered if you have chest pain that comes on with exertion or emotional stress and goes away with rest, es­pecially if you’re a man over 40 or a woman over 50. The test can also make sense if you have an ECG with abnormalities that prevent an accurate interpretation during an ECG treadmill test, or if you can’t exercise. Patients at higher risk, such as smokers or those with uncontrolled diabetes or high blood pressure, can also be candidates.

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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