Is a stress test effective for diagnosing atherosclerosis?

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A normal stress test only rules out severe atherosclerotic blockages in your coronary arteries. It can not rule out mild or moderate atherosclerotic buildup of plaque.

An active person without chest pain but with risk factors could have a normal stress test but a high coronary calcium score. This person may be at increased risk for having a heart attack, and proper counseling and treatment by a physician may be in order. 

For people who don’t know that they have atherosclerosis, but do have a family history of heart disease, a CT scan of the heart can yield a calcium score without using contrast and with less radiation than a CT coronary angiogram. A coronary calcium score allows your doctor to proceed with different intensities of treatment.