• How Your Doctor Chooses Tests


    Tests are critical to diagnosing and evaluating cardiovascular disease and the progress being made from treatment. They deliver data to your physician that can confirm the presence or extent of disease and that can suggest a course of action based on professional guidelines for your physician’s area of practice. In that regard, they are part of the science of medicine. But they also factor into the art of medicine as well. Your physician will use his or her experience, training, and education, as well as the professional guidelines, to determine which tests to order and what those tests mean for treatment. Your physician’s professional judgment is as important as the tests themselves.

    If you have any questions or concerns about a test a physician has recommended, ask your treating physician or practitioner. (For a list of sample questions, see below.)

    Most cardiac tests carry minimal risk, but risks versus benefits vary by test type. Remember, as the patient, you are also a part of your care decisions. Before you undergo certain types of tests (MRA, CT scan, angiogram), you will be advised of the risks and benefits of the test and will be asked to sign a form giving your informed consent. Ultimately, the goal of testing will be to guide treatment that can be life-saving or improve quality of life.

    Here are some common reasons your physician may recommend cardiovascular disease testing. You:

    • Have symptoms that suggest cardiovascular disease
    • Have risk factors for cardiovascular disease
    • Are about to undergo surgery and may be at risk for complications
    • Are being treated for cardiovascular disease and the physician wants to verify that treatment is working

    The Science of Medical Testing

    To learn more about how individual types of tests work, visit SecondsCount’s A-to-Z Guide to Heart Tests. Medical professionals within cardiovascular medicine are guided by standards in the field called appropriate use criteria, which describe best practices for conducting tests and performing procedures. Appropriate use criteria are detailed recommendations that are developed and reviewed by the world’s leading experts in the field and published by medical societies such as the Society for Cardiovascular Angiography and Interventions,  the American College of Cardiology,  and the American Heart Association,  among others.

    The Art of Medical Testing

    Sometimes a test may not provide a complete picture of a patient’s cardiovascular health. That is where a physician’s experience is vitally important. Consider the following case study:

    Cynthia, who is 55 years old, has been having fatigue, nausea, and a feeling of pressure in her chest. An exercise stress test doesn’t reveal any problems with her heart. However, her physician sees, based on lab tests, that Cynthia has high cholesterol and high blood pressure. A family history reveals that Cynthia’s mother died from a heart attack at age 60. Cynthia’s physician recommends that she undergo an angiogram - a minimally invasive test in which a thin tube called a catheter is guided through a puncture site in the skin and threaded through an artery to the heart where a special contrast dye is injected into the artery. This dye makes it possible to take an x-ray movie of the heart and blood vessels. In Cynthia’s case, the angiogram reveals coronary artery disease that was missed by the stress test.

    While stress tests are a good diagnostic tool, they are not 100 percent accurate. In this case, the physician’s expertise in considering factors beyond the stress test helped identify disease in Cynthia that could have been missed. Ultimately, the thinking behind which tests to order is just as important as the tests themselves.

    Click here for questions that can help you start a conversation with your physician/practitioner about recommended cardiovascular tests.