Choosing Wisely is an initiative by the ABIM Foundation to identify commonly-used tests or procedures whose necessity should be questioned and discussed. This information was developed by Consumer Reports in cooperation with the American Academy of Family Physicians.

If you have chest pain or other symptoms of heart disease, an electrocardiogram (EKG) or exercise stress test can be lifesaving. The same is true if you have a history of heart disease or are at very high risk for it. But in other cases, you should think twice. Here’s why.

The tests usually aren’t necessary for people without symptoms

With an EKG, electrodes attached to your chest record your heart’s electrical activity. When an EKG is done as you walk or jog on a treadmill, it’s called an exercise stress test. If you have symptoms of heart disease or are at high risk for it, both can help determine your chances of having a heart attack and help you and your doctor decide how to treat the problem.

But the tests are less accurate for lower-risk people and often have misleading results. Yet many people without symptoms of heart disease get the tests as part of their routine checkup. For example, in a 2010 Consumer Reports survey of nearly 1,200 people between the ages of 40 and 60 with no history of heart disease or heart-disease symptoms, 39 percent said they had undergone an EKG during the previous five years and 12 percent said they had an exercise stress test.

They can pose risks

EKGs and exercise stress tests won’t harm you directly. But both can produce inaccurate results that trigger follow-up tests that can pose risks. Those include CT angiography, which can expose you to a radiation dose equal to 600 to 800 chest X-rays, and standard coronary angiography, an invasive procedure that exposes you to further radiation. The risk posed by any one source is uncertain, but the effect of radiation is cumulative, so it’s best to avoid exposure when you can. Inappropriate testing can also lead to over-treatment with drugs or even angioplasty, a procedure that can ease the symptoms of heart disease but for many people is no better than lifestyle changes and medication—and triggers heart attacks in one to two percent of patients.

They can be a waste of money

An EKG typically costs about $50 and an exercise stress test about $200 to $300, according to HealthcareBlueBook.com. But any money spent on unnecessary tests is money wasted. And subsequent interventions prompted by unneeded tests can add thousands to the tab.

So when are the tests warranted?

An EKG and exercise stress test are often necessary if you have chest pain, shortness of breath, an irregular heartbeat or palpitations, or other symptoms of heart disease. They can also make sense for people with diabetes or other risk factors who are just starting to exercise.

Consumer Reports' Advice

How should you protect your heart?

People with or without symptoms of heart disease should take these steps:

Know your risk.
Factors such as your age, gender, cholesterol and blood-pressure levels, and whether you smoke or have diabetes can help determine which screening tests are right for you and whether treatment is necessary. (To use our calculator, go to ConsumerReports.org/heartrisk.)

Lower your risk.
Stop smoking; lose excess weight; engage in regular exercise, such as brisk walking; avoid food high in saturated fat, trans fats, and cholesterol; limit sodium; manage stress; and talk with your doctor about possibly taking low-dose aspirin.

Consider these tests:

Blood pressure.
Everyone should have a reading of the upper and lower numbers at least once a year by a doctor using a blood-pressure cuff.

Cholesterol.
Men 35 and older and women 45 and older who have heart risk factors should have a blood test at least every five years to measure LDL (bad) and HDL (good) cholesterol levels, as well as triglycerides, an artery-clogging fat.

Blood sugar.
People at risk for diabetes should have a blood test at least every three to five years to measure their blood glucose level.

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