Is nuclear stress test follow-up needed?

Dear Dr. Roach: I am a 69-year-old male who underwent bypass graft surgery in late 2014. I have been free of symptoms since. I exercise daily, maintain a healthy diet and have never smoked. I’m 5 feet, 7 inches tall and weigh 152 pounds. I’ve been on once-daily statin and metoprolol. BP and cholesterol numbers stayed normal.

My cardiologist has scheduled me next month for a carotid ultrasound, echocardiogram and a nuclear cardiac treadmill stress test in what he describes as a routine five-year follow-up. I read an article by the American Society of Nuclear Cardiology that stated such a test is rarely necessary in the absence of symptoms. Plus, it exposes one to radiation and may lead to false positives and further unneeded testing. I was not aware of this when this test was scheduled. Would it be prudent for me now to question my doc about whether this test is really needed? — K.B.

I agree with you completely. Stress tests did used to be recommended after bypass grafting, but no longer are. In people with no symptoms, surgery or other treatment to open up blood vessels with balloons and stents is not beneficial. Although the potential for harm is small, there is always a risk of a false positive test requiring invasive follow-up testing. Coronary angiography, which can damage blood vessels, is one example. The dye used in the test can occasionally damage the kidney.

Questioning your doctor about a test he has ordered is uncomfortable for some people, but most doctors don’t feel threatened by a respectful request to explain our reasoning. Medical care ideally includes shared decision making, and although many people defer entirely to their doctors, people will get better care if they share their concerns and desires with their doctors as logically as you have here. Write to Dr. Roach at ToYourGoodHealth@ med.cornell.edu or mail to 628 Virginia Dr., Orlando, FL 32803.

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