Choosing Wisely

Heart Stress Tests Before Surgery

When you need a test—and when you don’t

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If you’re having surgery, you may wonder if you need a heart stress test to make sure that it is safe for you to have surgery. You will probably not need the test if you are healthy, active, and feeling well, or if you’re having minor surgery. Here’s why:

The tests aren’t useful before minor surgery.

During an exercise stress test, you walk or jog on a treadmill with electrodes attached to your chest. In imaging stress tests, ultrasound and echocardiography take pictures of your heart using sound waves. A nuclear cardiology test uses a small amount of radioactive substance to take pictures of your heart while it is being stressed.

Heart stress tests can show if you have significant heart disease. This could put you at risk of having a heart attack or another serious complication during surgery. The test results may lead to special care during or after surgery, delaying the surgery, or changing to a less invasive kind of surgery.

But, there is a very low risk of heart complications from surgeries such as a breast biopsy, eye or skin surgery, a hernia operation, or a “same-day” surgery. The risk is so low for minor surgeries that even  most people with heart disease do well.

If you feel well and are physically active, your chance of having significant heart disease is low. So you usually don’t need a stress test, even for major surgeries.

Heart stress tests can pose risks.

The tests are usually very safe and some can be done with little or no radiation. But if your risk of having a heart problem is low, they are more likely to result in false alarms that could cause anxiety, an unneeded delay of surgery, or lead to more tests.

For example, if your stress test results are not normal, you might have a follow-up coronary angiography (cardiac catheterization). During this test, a catheter is inserted into the heart through an artery, dye is injected, and X-rays are taken. The risks are low, and there are rarely complications, but it can lead to bleeding, or even a heart attack, and death. Also, exposure to radiation adds up over your lifetime, so it’s best to avoid X-rays whenever you can.

Heart stress tests can cost a lot.

An exercise stress test costs $200 to $300, and an imaging stress test costs between $500 and $2,000. If abnormal results lead to coronary angiography, that can add another $5,000 to the cost.

When are stress tests needed before surgery?

Usually, stress testing should be done only when the results would change the plan for your surgery.

You might need a stress test before surgery if you have a serious heart condition. This includes uncontrolled heart failure or severe valve disease, chest pain or trouble breathing, or you get tired or winded more easily than you did before.

You might also need a stress test before surgery if you have the following risks:

  • You are having intermediate-risk surgery, such as knee or hip replacement, or high-risk surgery, such as bypass surgery for a blocked artery in your leg.
  • And you have diabetes, kidney disease, or a history of coronary artery disease, heart failure or stroke.
  • And you have a hard time walking a short distance or climbing stairs.

Advice from Consumer Reports

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2013 Consumer Reports. Developed in cooperation with the Society for Vascular Medicine. To learn more about the sources used in this report and terms and conditions of use, visit