Breathing Tests
Spirometry
Spirometry measures how much air you breathe in and out and how fast you blow it out. This is measured in two ways: peak expiratory flow rate (PEFR) and forced expiratory volume in 1 second (FEV1). PEFR refers to the amount of air you can blow air out as quickly as possible. FEV1 refers to the amount of air you can blow out in 1 second.
During the test, a technician will ask you to take a deep breath in and then blow as hard as you can into a tube connected to a small machine. Your doctor may have you inhale a medicine that helps open your airways. He or she will want to see whether the medicine changes or improves the test results.
Spirometry is done to look for diseases and conditions that affect how much air you can breathe in, such as sarcoidosis or lung tissue scarring. It's also done to look for diseases that affect how fast you can breathe air out, like asthma and COPD (chronic obstructive pulmonary disease).
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Carotid Ultrasound
Carotid (ka-ROT-id) ultrasound is a painless and harmless test that uses high-frequency sound waves to create images of the insides of the two large arteries in your neck. These arteries, called carotid arteries, supply your brain with blood. You have one carotid artery on each side of your neck.
Carotid ultrasound shows whether a material called plaque (plak) has narrowed your carotid arteries. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. It builds up on the insides of your arteries as you age.
Too much plaque in a carotid artery can cause a stroke. The plaque can slow down or block the flow of blood through the artery, allowing a blood clot to form. A piece of the blood clot can break off and get stuck in the artery, blocking blood flow to the brain. This is what causes a stroke.
A standard carotid ultrasound shows the structure of your carotid artery. Your carotid ultrasound test may include a Doppler ultrasound. Doppler ultrasound is a special ultrasound that shows the movement of blood through your blood vessels. Your doctor often will need results from both types of ultrasound to fully assess if there is a problem with blood flow through your carotid arteries.
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Echocardiography
Echocardiography (EK-o-kar-de-OG-ra-fee) is a painless test that uses sound waves to create images of your heart. It provides your doctor with information about the size and shape of your heart and how well your heart’s chambers and valves are working.
The test also can identify areas of heart muscle that aren’t contracting normally due to poor blood flow or injury from previous heart attack(s). In addition, a type of echocardiography called Doppler ultrasound shows how well blood flows through the chambers and valves of your heart. Echocardiography can detect possible blood clots inside the heart, fluid buildup in the sac around the heart (pericardium), and problems with the aorta (the main artery that carries oxygen-rich blood out of the heart).
Who Needs Echocardiography?
Your doctor may recommend echocardiography if you’re suffering from signs and symptoms of heart problems. For example, symptoms such as shortness of breath and swelling in the legs can be due to weakness of the heart (heart failure), which can be seen on an echocardiogram.
Doctors also use echocardiography to provide information on:
- The size of your heart. An enlarged heart can be the result of high blood pressure, leaky heart valves, or heart failure.
- Heart muscles that are weak and aren’t moving (pumping) properly. Weakened areas of heart muscle can be due to damage from a heart attack. Or weakening could mean that the area isn’t getting enough blood supply, which can be due to coronary artery disease.
- Problems with your heart’s valves. Echocardiography can show whether any of the valves of your heart don’t open normally or don’t form a complete seal when closed.
- Abnormalities in the structure of your heart. Echocardiography can detect a variety of heart abnormalities, such as a hole in the septum (the wall that separates the two chambers on the left side of the heart from the two chambers on the right side) and other congenital heart defects (structural problems present at birth).
- The aorta. Echocardiography is commonly used to assess and detect problems with the aorta such as aneurysm (abnormal bulge or “ballooning” in the wall of an artery).
- Blood clots or tumors. If you have had a stroke, echocardiography might be done to check for blood clots or tumors that may have caused it.
Doctors also use echocardiography to see how well your heart responds to certain heart treatments, such as treatment for heart failure.
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Electrocardiogram
An electrocardiogram (e-lek-tro-KAR-de-o-gram), or EKG, is a simple, painless test that records the heart's electrical activity. To understand this test, it helps to understand how the heart works.
With each heartbeat, an electrical signal spreads from the top of the heart to the bottom. As it travels, the signal causes the heart to contract and pump blood. The process repeats with each new heartbeat. The heart's electrical signals set the rhythm of the heartbeat.
An EKG shows:
- How fast your heart is beating
- Whether the rhythm of your heartbeat is steady or irregular
- The strength and timing of electrical signals as they pass through each part of your heart
This test is used to detect and evaluate many heart problems, such as heart attack, arrhythmia (ah-RITH-me-ah), and heart failure. EKG results also can suggest other disorders that affect heart function.
EKGs also are used to monitor how the heart is working.
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Holter and Event Monitors
Holter and event monitors are medical devices that record the heart's electrical activity. Doctors most often use these monitors to diagnose arrhythmias (ah-RITH-me-ahs). These are problems with the speed or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or irregularly.
Holter and event monitors also are used to detect silent myocardial ischemia (is-KE-me-ah). In this condition, not enough oxygen-rich blood reaches the heart muscle. "Silent" means that no symptoms occur.
These monitors also can check whether treatments for arrhythmia and silent myocardial ischemia are working.
This article focuses on using Holter and event monitors to diagnose problems with the heart's speed or rhythm.
Overview
Holter and event monitors are similar to an EKG (electrocardiogram). An EKG is a simple test that detects and records the heart's electrical activity. It's the most common test for diagnosing a heart rhythm problem.
However, a standard EKG only records the heartbeat for a few seconds. It won't detect heart rhythm problems that don't occur during the test.
Holter and event monitors are small, portable devices. You can wear one while you do your normal daily activities. This allows the monitor to record your heart for a longer time than an EKG.
Some people have heart rhythm problems that only occur during certain activities, such as sleep or physical exertion. Using a Holter or event monitor increases the chance of recording these problems.
Although similar, Holter and event monitors aren't the same. A Holter monitor records your heart's electrical activity the entire time you're wearing it. An event monitor only records your heart's electrical activity at certain times while you're wearing it.
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Nuclear Heart Scan (Stress Test)
A nuclear heart scan is a type of medical test that allows your doctor to get important information about the health of your heart. During a nuclear heart scan, a safe, radioactive material called a tracer is injected through a vein into your bloodstream. The tracer then travels to your heart. The tracer releases energy, which special cameras outside of your body detect. The cameras use the energy to create pictures of different parts of your heart.
Nuclear heart scans are used for three main purposes:
- To provide information about the flow of blood throughout the heart muscle. If the scan shows that one part of the heart muscle isn’t receiving blood, it’s a sign of a possible narrowing or blockage in the coronary arteries (the arteries that supply blood and oxygen to your heart). Decreased blood flow through the coronary arteries may mean you have coronary artery disease (CAD). CAD can lead to angina, heart attack, and other heart problems. When a nuclear heart scan is performed for this purpose, it’s called myocardial perfusion scanning.
- To look for damaged heart muscle. Damage may be due to a previous heart attack, injury, infection, or medicine. When a nuclear heart scan is performed for this purpose, it’s called myocardial viability testing.
- To see how well your heart pumps blood out to your body. When a nuclear heart scan is performed for this purpose, it’s called ventricular function scanning.
Usually, two sets of pictures are taken during a nuclear heart scan. The first set is taken when the heart is beating fast due to you exercising. This is called a cardiac stress test. If you can’t exercise, your heart rate can be increased using medicines such as adenosine, dipyridamole, or dobutamine.
The second set of pictures is taken later, when the heart is at rest and beating at a normal rate.
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Smoking Cessation
Cigarette smoking greatly increases the risk of fatal and nonfatal heart attacks in both men and women. It also increases the risk of a second heart attack among survivors. Women who smoke and use oral contraceptives have an even greater risk than smoking alone. The good news is that quitting smoking greatly reduces the risk of heart attack. One year after quitting the risk drop to about one-half that of current smokers and gradually returns to normal in persons without heart disease. Even among persons with heart disease, the risk also drops sharply one year after quitting smoking and it continues to decline over time but the risk does not return to normal.
The Virtual Office of the Surgeon General is a Web site of the U.S. Surgeon General. It contains information to help smokers quit. The U.S. Food and Drug Administration has approved five medications to help you stop smoking and lessen the urge to smoke. They are:
- Bupropion SR - available by prescription
- Nicotine gum - available over-the-counter
- Nicotine inhaler - available by prescription
- Nicotine nasal spray - available by prescription
- Nicotine patch - available by prescription and over-the-counter
All of these medicines will more or less double your chances of quitting and quitting for good.
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