Stress Test
During an exercise stress test, your heart is monitored while you walk on a treadmill or ride a stationary bike. This helps your doctor figure out how well your heart works when it’s pumping hard and fast. Some doctors may have included these in routine checkups in the past, but that’s no longer recommended. Still, about half of all stress tests ordered may be inappropriate, according to a 2022 AHA report.
“It shouldn’t be done as a routine test, period,” says Weintraub. Stress tests can incorrectly suggest there are no significant coronary blockages (a false negative) or incorrectly suggest there are significant ones (a false positive). Some research suggests that the rates of false negatives and positives may be up to 20 percent, Newby says. “This could lead to unnecessary tests that are more invasive, like coronary angiograms, or failure to detect and treat,” she says.
Weintraub says a stress test should be done if you have symptoms that suggest coronary artery disease, such as shortness of breath or chest pain when you walk. “In these cases, stress tests can be very useful and give us a sense of how extensive coronary artery disease really is,” he says.
Electrocardiogram (EKG)
Small patches (electrodes) are attached to your arms, legs, and chest to record your heart’s electrical activity. This can tell if there’s abnormal activity that might indicate heart disease. “Some doctors still do them every year in patients age 50 or older, but they’re definitely low value as a general screening tool,” Ruthmann says. In fact, the USPSTF doesn’t recommend routine EKGs for people of any age who have no symptoms of heart disease or risk factors for a heart attack or stroke.
But Ruthmann recommends having a baseline EKG in certain cases, such as if you have heart disease risk factors like hypertension, to help give your doctor an overall picture of your heart health. If it’s normal, there’s no need to repeat the test unless you experience symptoms such as heart palpitations, you’ve received a heart disease diagnosis, or you have a history of heart attack or stroke.
Echocardiogram
This ultrasound checks the structure and function of your heart. About 20 percent of “echos” ordered may be inappropriate, according to the 2022 AHA report. “These ultrasounds are overused because they are so easy to use,” Weintraub says. “The echo machines used to be the size of a big fridge, but now they’re the size of a laptop.” In some cases, an echo done during a routine heart checkup may find something minor, “like a slight valve leak that’s actually still normal, but the doctor wants to monitor it and it leads to annual follow-ups,” Ruthmann says. “It creates a lot of unnecessary repeat echos, and a lot of anxiety for patients.”
An echo is warranted when you show signs of heart disease, says Vinay Kini, MD, a cardiologist at Weill Cornell Medicine in New York City and a co-author of the 2022 AHA report. “It’s very helpful if we suspect a structural or valvular heart problem, especially if paired with symptoms of heart disease or heart failure, such as shortness of breath and leg swelling,” he says.
Coronary Calcium Scan
This imaging test checks for calcium deposits in your heart arteries. “If you have a buildup of calcium, it can narrow the arteries and reduce blood flow to your heart,” Kini says. It’s not recommended for routine use but can help if it’s unclear whether you should begin taking cholesterol-lowering drugs. “If someone’s risk factors place them right on the border, the level of calcium in their arteries can give us a sense of whether they should start statins or not,” Kini says.
Cardiac MRIs and coronary CT scans
These use X-ray beams (CT) or radio waves (MRI) to get 3D images of your heart, which are more detailed than those from an echocardiogram. But coronary CT scans aren’t considered very reliable for older adults. Cardiac MRIs are, but take more time to do than other heart tests, they’re costly, and they’re usually limited to large medical centers, Ruthmann says.
