11 Screening Tests for Your Heart

3. Blood sugar

You may not think of this as a heart screening, but a high blood sugar level increases your risk for insulin resistance, prediabetes and type 2 diabetes — and those can lead to stroke or heart disease. The doctor may request a blood glucose test along with a glycated hemoglobin (A1C) test to see how your body processes sugars. Both are simple blood tests.

4. Electrocardiogram

Also known as an ECG or EKG , this measures your heartbeat’s electrical activity. It can tell if your heart’s electrical activity is normal, and if parts of the heart are working too hard. The test can determine if you’ve experienced a heart attack or if one is developing.

Some primary care doctors perform this test during a regular checkup to check blood flow, Alpert says. He likes to do it so he has something on record to look back on if a patient has any cardiovascular-related symptoms in the future.

“The electrocardiogram is a baseline,” Alpert says, that can show patterns and tell if someone is at risk for arrhythmia.

How it’s done: The technician will attach electrodes that stick to your chest, arms and legs. You won’t feel a thing as the sensors send data to a monitor for a few minutes.

Very often, if everything looks good on your EKG or the three aforementioned tests, that’s where basic heart health screening stops, Alpert says.

Specialized screening tests

Your doctor might order these tests to get a clearer picture of your heart health —whether to check your risk factors or look for signs of a heart condition:

5. Calcium scan

If you or your doctor are unsure about starting cholesterol-lowering medication — or if you have a family history of heart disease and want to check for calcium buildup in your arteries — Alpert says a calcium score test can help guide the decision. It’s a low-voltage computed tomography (CT) scan that’s noninvasive and takes approximately 15 minutes, with the actual scanning duration being less than that.

If the test reveals calcium buildup, it doesn’t mean you’re having a heart attack — just that the atherosclerosis process has started, which can lead to coronary artery disease (CAD). You can still decrease your risk with intervention, Alpert says.

“When the calcium starts, that’s when you start the statin,” Alpert says of the class of drugs that can lower cholesterol, though there are non-statin options. 

Not everyone on a statin or other cholesterol-lowering medication needs to undergo this test, Kulshreshtha says. And it’s not often covered by insurance, Alpert says, so you may need to pay for it out of pocket.

How it’s done: The technician will attach electrodes around your chest and monitor your heartbeat as you pass through the computed tomography (CT) machine. 

6. Echocardiogram

This test uses sound waves to create detailed images of your heart, showing how it beats and how blood flows. It helps doctors spot problems with your valves or heart muscle and assess overall heart function, including signs of disease or murmurs.

A few different types of echocardiograms exist: transthoracic echocardiogram (TTE), also known as a heart ultrasound; transesophageal echocardiogram (TEE); exercise stress echocardiogram; and dobutamine stress echocardiogram. The test is performed in a cardiologist’s office or hospital, and takes about one hour.

How it’s done: You’ll likely have electrodes stuck on your chest, and the technician will move a wand over your heart. Depending on the type of echocardiogram you receive, it may involve injecting dye into your body so the health care provider can better interpret images.

7. Holter monitor test

If your electrocardiogram doesn’t provide your doctor with enough information, they may recommend that you have this test. This is a form of an echocardiogram  for people who may have arrhythmia and have a history of irregular heartbeats. The wearable device accompanies you for at least 24 hours to track your heart activity over time.

How it’s done: The clinician attaches electrodes to your chest and to a portable device that you wear for at least a day. Then you return it to the clinic, and the doctor analyzes the results.

8. Stress test

Also known as a treadmill test, this is a common test if your doctor is assessing whether you have heart disease. By monitoring your heart while you’re on a treadmill or bike for about 15 minutes, the exam can show blocked arteries and reveal damage from CAD. It’s also used after a cardiac event to see how much physical activity you can handle. They were once used more frequently in primary care settings, but now, not as much, Kulshreshtha notes.

If your health care provider recommends a nuclear stress test — also called a myocardial perfusion imaging (MPI) test — they will use an imaging machine to take pictures of your heart before and after you receive a small amount of a radioactive tracer. An imaging machine takes pictures of how the tracer moves through the heart arteries as you exercise to find areas of poor blood flow or damage in the heart.

The images only take about 20 minutes, but the wait times between pushes this to a couple of hours in total. In a similar test, the pharmacological nuclear stress test, the clinician may administer medication to increase your heart rate and simulate exercise. It usually takes a few hours in total as well.

Other types of stress tests include an exercise stress echocardiogram, which involves conducting an echocardiogram both before and at the peak of your exercise session. It takes about one hour.

The length of the test depends on the type of stress test.

How it’s done: For the tests involving exercise, you’ll walk on a treadmill or pedal on an exercise bike while hooked up to an EKG machine. Incline and speed may vary to help the doctor evaluate your blood flow. 

9. Lipoprotein(a) or apoB

Also known as Lp(a), this lipoprotein isn’t part of the typical lipid panel that your primary care doctor may order. Lp(a) is a genetically inherited lipoprotein, so the test can be ideal for those with a family history of early heart disease, as the test is an “independent predictor of heart disease,” Kulshreshtha explains.

Lp(a) facilitates the movement of cholesterol into the arteries and can show up in plaque. (It’s also in cells lining our small blood vessels, and found in tissues during the healing process.)

Lp(a) contains two main proteins: apolipoprotein(a) [apo(a)] and apolipoprotein B (apoB)-100. Just like having high Lp(a), high apoB is also linked with a higher risk of heart disease. Doctors can also test for apoB.

The test measures the amount of Lp(a) in your blood, as elevated levels are associated with an increased risk of heart disease. Diabetes and chronic kidney disease can increase levels, as can going through menopause.

The test is usually ordered if your doctor thinks you’re at high risk for a cardiovascular issue or if high levels run in your family. Currently, the medical community is evaluating whether Lp(a) and apoB tests should be added to the standard lipid panel, Kulshreshtha says.

How it’s done: A technician draws blood, and a lab evaluates the results.

10. Coronary CT angiography (CCTA)

This test enables the doctor to assess the extent of plaque buildup and determine if there are any narrowing or blockages in your coronary arteries.

How it’s done: The clinician will apply electrodes to your chest and may administer medication to slow your heart rate and obtain clearer images. They’ll inject a contrast material into your coronary arteries, and you will undergo a CT scan. It can take about 15 minutes.

11. Coronary catheter angiography 

This test, a form of cardiac catheterization, captures images of the blood flow in your coronary arteries and spots any blockages or narrowing. It’s often suggested to diagnose CAD.

How it works: Your doctor will insert a thin catheter into one of your arteries, then guide it into the heart while you’re awake or sedated. From there, they’ll inject a contrast material and take X-rays. The test takes about one hour.