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Ask the doctor: Preventive stress tests?

Ask the doctor

Preventive stress tests?

Q. I haven’t had such good luck with my heart — a heart attack ten years ago and angioplasty with two stents inserted last year. Would it make sense for me to have a yearly stress test? If I had been doing that after my heart attack, maybe my doctor would have seen the blockage and we could have done something about it earlier.

A. As long as you are free of chest pain, shortness of breath, and other symptoms that indicate heart disease, you don’t need any type of stress test.

That’s not only my opinion, and what I tell my patients, but a bare-bones summary of guidelines from the American College of Cardiology and American Heart Association. The experts who put together these guidelines recommend stress testing after angioplasty only for individuals who develop new symptoms.

Why? In people who don’t have symptoms of heart disease, an abnormal stress test isn’t enough evidence for a repeat angioplasty. Since the test doesn’t really change the management plan, its use is discouraged.

The best thing you can do to avoid a repeat engagement with a heart attack or stent is to take care of your heart day by day. This means doing your best to control your cholesterol, blood pressure, and weight, eating as healthful a diet as you can, and exercising regularly.

If you feel any chest pain, tightness, or other discomfort when you exercise, climb stairs, are under a lot of stress, or do other things that make your heart work harder, then a stress test with an echocardiogram or nuclear imaging would be the right thing to do.

— Thomas H. Lee, M.D. Editor in Chief, Harvard Heart Letter

Last updated:	August 21, 2006