Protection Products

Ask an Underwriter: Cardiac Complications


When you come across clients with a cardiac history, there’s no one-size-fits-all solution for insurance. Different diagnoses or symptoms require different tests … and lead to different outcomes for underwriting.  

First of all, cardiac disorders or diseases affect the heart in different ways: 

  • Atrial fibrillation (irregular rhythm), sinus bradycardia (very slow heart rate) or tachycardia (very fast heart rate) are disruptions in the “electrical” system or the “wiring” of the heart muscle

  • High blood pressure or coronary artery disease are circulatory disorders

  • Cardiomyopathy, congenital and/or acquired abnormalities (diseases which can affect the heart muscle or valves) are muscular or structural disorders 

The category or type of heart disease an individual is treated for will dictate the diagnostic or routine cardiac exam and/or testing they will undergo. 


“Electrical” disruptions

The basic heart exam will consist of review of symptoms and vital statistics (blood pressure, pulse and oxygen levels), plus a stethoscope exam and a resting electrocardiogram (EKG). If further evaluation is needed, a Holter monitor (a continuous recording of a person’s heart rhythm) may be ordered as well as an echocardiogram (ECHO – a type of ultrasound test that uses sound waves to create pictures of the heart).


Circulatory disorders

Exams and testing will include a basic cardiac exam, with a resting EKG and blood work. If further evaluation is needed, there may be one or more of the following tests: stress test or stress test with nuclear imaging (measures a heart’s response to exertion or stress and is induced by exercise or drug stimulation), ECHO, stress ECHO, or cardiac CT angiography. Depending on findings, a more invasive exam, such as cardiac catheterization, may be required.


Muscular or structural disorders

Testing will include the basic cardiac exam, a chest x-ray, and an EKG.  Depending on symptoms and findings, additional testing can include one of more of the following:  ECHO, stress ECHO, cardiac MRI or CT, cardiac catheterization, or a cardiac biopsy.


Underwriting Assessment

When considering an applicant with a cardiac history of any kind, a life insurance underwriter hopes to see that the individual:  

  • Goes to regular follow-up visits with their doctor
  • Follows all treatments, including medication, changes in diet, or exercise (if recommended)
  • Has up-to-date, routine serial cardiac testing (stress test, ECHO, etc.) with results that show stability of the underlying disorder, as well as good heart function

By proving they’re compliant with treatments and doing well, applicants with a cardiac history may be considered more favorably in underwriting, giving them more favorable options for coverage.  

With so many variables involved – from the diagnosis/treatment details to carrier risk assessment – we’ve created three comprehensive questionnaires to assist you in your fact-finding efforts. 

No matter the situation, we encourage you to ask questions and get all the facts. Have a specific question? Check out the resources below or drop me a line and we'll be happy to help.


Learn More


About the Author

For more than 34 years, Charlie Kuhn has taken a personal interest in every case. To her, it’s more than a file – it’s a person trying to protect the people they care about, and she can think of no better vocation than to help provide financial and emotional security for others. Through her personal commitment to continuous professional growth, Charlie is one test away from becoming an Associate of the Life Management Institute. She is already an Associate of Customer Service with LOMA, has passed all three of the Academy of Life Underwriting exams, and is certified in EKG interpretation.



underwriting cardiac heart