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LIFELONG HEALTH- Too Many Cardiac Tests, Treatments Occur In U.S. PDF Print E-mail
Written by Dr. David Lipschitz Creative Syndicate   
Thursday, 30 August 2012 03:19

Hundreds of thousands of healthy Americans have an annual electrocardiogram, EKG, and stress test to screen for coronary artery disease. The stress test can be done in one of two ways. The heart can be stressed either by exercising on a treadmill while monitored by an EKG or by injecting a radioisotope and scanning the heart before and after exercise. If exercise is difficult, the heart can be stressed by injecting the medication persantine. In either case, abnormalities can identify coronary artery disease.

The U.S. Preventive Services Task Force recently reaffirmed the opinion of many experts by recommending against routine EKGs and stress tests for healthy individuals at a low risk of having heart disease and who have no symptoms, such as chest pain or shortness of breath. The task force found the tests often yield false results, leading to needless additional investigations that may cause more harm than good.

Furthermore, a normal test is not a good predictor of future cardiac risk problems.

Even for those at a higher risk of heart disease, the task force does not believe there is enough evidence either for or against EKG and stress testing, and it suggests that a decision be made on a case-by-case basis between doctor and patient. So how do you determine your risk for having a heart attack? This can easily be accomplished by entering information into a risk assessment tool developed by the American Heart Association at

Their heart-attack risk calculator factors in the common conditions that contribute to a higher chance of having a heart attack: age, being a male or a post-menopausal female, strong family history of heart attacks, high blood pressure, elevated LDL (bad) cholesterol, a fasting blood sugar count greater than 100, smoking, being overweight, being sedentary and eating poorly. Once completed, the tool provides information about the risk of having a heart attack within 10 years (mine is 12 percent) and what steps should be taken to address any problems.

As heart disease is clearly the leading cause of death, it is fair to assume that everyone is in some danger. So taking steps to improve your heart health is far more important and valuable than finding out during a stress test that significant coronary artery disease is already present.

This means being compulsive about living a heart healthy lifestyle, including exercising, eating right, not smoking and managing stress, as well as working closely with a physician to identify and correct treatable risk factors.

If heart attack risk is moderatemoderate or high, a dialogue with a primary-care physician or cardiologist to determine if a stress test should be done is appropriate.

And for someone whose assessment indicates a very high risk of a heart attack within the next 10 years, a screening stress test is a realistic consideration. But there must be an understanding that the result may lead to angiograms, angioplasty or even open-heart surgery.

No matter your risk, should symptoms develop — such as shortness of breath or chest pain — a stress test is then used as a diagnostic rather than a screening tool. Some experts may even forgo a stress test and opt for an immediate angiogram if symptoms are sufficiently compelling.

For anyone who is known to have coronary artery disease but is being optimally managed with medications and has either no or stable symptoms, annual stress tests may do more harm than good. In this circumstance, any invasive procedure to open a blocked artery (by angioplasty using stents or surgery) will neither prolong life nor reduce the risk of a heart attack. Invasive procedures will relieve symptoms, but sadly, angiograms and even open-heart surgery are done frequently on individuals with no symptoms at all.

Nothing is scarier than dealing with a heart problem. The evidence is compelling that aggressive diagnostic and invasive procedures are highly effective when done for the appropriate indication. But numerous studies have shown that aggressive care is frequently unnecessary. In relation to heart health, the more you know and the more involved you are, the better.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz visit

Last Updated on Thursday, 30 August 2012 03:20

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