Chest examination consists of inspection, palpation, percussion, and auscultation. The inspection process initiates and continues throughout the patient encounter. Palpation, confirmed by percussion, assesses for tenderness and degree of chest expansion. Auscultation, a more sensitive process, confirms earlier findings and may help to identify specific pathologic processes not previously recognized.
Chest expansion must be assessed to determine the depth and quality of movement on each side of the chest. Both sides should be assessed for symmetry. Unilateral decreased chest expansion, which is easier to detect, indicates pathology on that side, for example, pneumothorax, pleural effusion, pneumonia, and collapsed lung. Bilateral decreased chest expansion, which is more difficult to detect, is often seen in asthma and COPD. The symmetry and degree of chest expansion can be more accurately evaluated by observing chest movement than by palpating the chest wall (Ford et al, 2005).
Inspection
The respiratory rate may increase with the presence of an interstitial pulmonary process or chest wall restriction, but tidal volume typically remains unchanged. The presence of slow, gasping ventilatory maneuvers is an ominous sign suggesting cerebral hypoxemia.
Dysrhythmic breathing is typified by Cheyne–Stokes respiration. This eponym refers to a periodic pattern of alternating hyperpnea and apnea. Though at times, it is a normal phenomenon seen in infants, the elderly, and during ascent to altitude, more often it is a reflection of significant cardiac and/or pleural nervous system dysfunction.
Breath volumes are increased without substantial modification of rate as a compensatory mechanism to blunt the effects of metabolic acidosis such as occurs with uncontrolled diabetes. When this occurs, the effort associated with this Kussmaul breathing seems to be minimal.
The configuration of the chest may aid in the diagnostic process. Typically, pectus excavatum (funnel chest) or its counterpart pectus carinatum (pigeon breast) are associated with unequivocal physical findings but rarely have an adverse impact on pulmonary function. Scars identify previous surgery or trauma and alert the clinician to the need for a complete history of the event. The so-called barrel chest deformity, sometimes referred to as increased A–P diameter, often erroneously is interpreted as associated with the presence of pulmonary emphysema. Several studies have proved that this description is not necessarily associated with underlying pulmonary disease but regularly is a function of weight loss and mild kyphosis, a function of the aging process.
During breathing, assessment of changing chest shape can be more helpful. The presence of intercostal retraction, pursued-lip breathing, and use of accessory muscles suggest airways obstruction. Paradoxical movement of the chest and abdominal muscles should alert the clinician to the possible usefulness of pulmonary physiotherapy to improve ventilatory efficiency. Grimaces or other expressions of discomfort occurring at the same point in each ventilatory cycle should influence the examiner to identify the origin of that discomfort more precisely. Finally, wheezing heard by the examiner during tidal volume breathing or exaggerated breathing may be a reflection of upper airway obstruction (stridor) or severe lower airway narrowing. The search for dermatologic abnormalities also may lead one to the identification of other systemic or pulmonary processes.
Palpation
Palpation is used both as a screening technique and as a means to confirm a specific diagnosis. Light palpation over the entire thorax posteriorly, laterally, and anteriorly will aid in the identification of cutaneous and subcutaneous nodules and the site of previously unsuspected tenderness. Nodules that are firm and freely moveable suggest a focal benign inflammatory or clinically insignificant problem. Those that are hard, fixed, and multiple suggest metastatic malignancy. Fleshy nodules may be indicative of a systemic disease such as neurofibromatosis.
Tenderness may be elicited during this same maneuver. At times, it is unsuspected by both the patient and the examiner. Under other circumstances, it is used to aid in a diagnosis of the complaint of chest pain. Localizing a rib fracture, either traumatic or pathologic, or reproducing the chest pain of costochondritis by firm palpation of an inflamed costochondral junction may be most helpful in planning further management. Tenderness over an inflamed or infarcted area of lung may also aid in the localization of the disease process.
Assessment of ventilatory excursion includes evaluation of the synchrony of expansion and the degree of chest expansion associated with a deep forceful inspiration from residual volume. Asymmetrical expansion invariably implies decreased ventilation to one side. This may be due to thoracic wall abnormalities, particularly those that are either associated with structural immobility or defect (thoracoplasty) or pain (rib fracture). Similarly, the problem may be caused by an inflamed, fibrosed, or malignantly infiltrated pleura, a unilateral pleural effusion, an interstitial pulmonary process, or a complete obstruction of an airway or airways on the ipsilateral side. Functional severing of the phrenic nerve or intraabdominal process causing paralysis of the ipsilateral hemidiaphragm may be responsible for asymmetrical expansion. Asynchronous expansion may occur secondary to these processes but usually occurs with functional diaphragmatic impairment or pain.
Palpation is used to assess further abnormalities; gynecomastia suspected because of observed breast enlargement is confirmed by the palpation of breast tissue. Similarly, spider hemangiomas are confirmed when the central arterial supply is seen to feed the spider’s radicals following manual occlusion.
Finally, deviation of the trachea to one side can mean that a process is either pulling the trachea to one side, such as occurs with lung volume loss (lobar collapse, atelectasis, pneumothorax), or pushing the trachea away, such as might occur with either a tumor or an inflammatory mass. Spontaneous movement of the trachea in synchrony with the pulse suggests the presence of an aortic aneurysm.
Percussion
Percussion is a major aid in the assessment of ventilatory exertion, the assessment of hyperinflation, and the presence of focal thoracic disease.
The general percussion over a hemithorax can give a clue as to the presence or absence of a pulmonary process. When the percussion note is hyper resonant, one can postulate that the lungs are hyperinflated, such as may occur with emphysema or during so-called air trapping seen in patients with acute asthma. This may also occur in patients with an acute spontaneous pneumothorax. Dullness to percussion, particularly associated with the presence of a high, poorly moving diaphragm, is likely to be associated with a restrictive ventilatory defect if the findings are bilaterally symmetrical. Usually, this is associated with an interstitial pulmonary process that can be further evaluated by the presence or absence of late inspiratory crackles on auscultation. Flatness to percussion suggests the virtual absence of air directly beneath the percussed finger and may reflect either fluid in the pleural space (pleural effusion, empyema), solid material in the pleural space (fibrothorax, mesothelioma), or atelectasis.
Auscultation
Bronchial breath sounds may be either normal or abnormal. When they are heard on the periphery, where vesicular breath sounds are normally heard, one can imply that the airways to the lung units are open but that the lung units themselves are filled with liquid-like material. When this occurs without pleural fluid, the bronchial breath sounds are loud; when consolidation is associated with a pleural effusion, the bronchial breath sounds are present but often quite decreased in intensity. Confirmation of the presence of bronchial breath sounds can be obtained by listening for egophony (“E to A” sound). This sound is elicited by asking the patient to say the letter “E” as one listens over the suspicious area with the stethoscope. When consolidation is present, the spoken “E” sound is converted to an ausculted “A” sound, similar to that produced by a bleating goat.
In addition to assessing the quality of breath sounds, it is also important to assess the duration of the expiratory phase. Timing the duration of expiratory sound while listening with the diaphragm over the trachea during a forced expiratory volume maneuver is used to identify airways obstruction. Expiratory sound should terminate within 6 seconds. If the sound is prolonged, airways obstruction manifested by an FEV1 of less than 1.5 liters can be assumed.
Auscultatory wheezes imply the presence of slitlike openings through which a critical velocity of gas is passing. When wheezes are local, one must consider external compression of an airway. Enlarged lymph nodes and tumors do this. A lesion within the airway, such as an endobronchial malignancy or foreign body, also can produce a localized wheeze. Diffuse wheezing is present in inflammatory processes such as bronchitis (both acute or chronic), contraction of hypertrophied bronchial smooth muscle as seen in asthma, inspissated thick secretions of pneumonia, and airway collapse associated with the dynamic compression of pulmonary emphysema.
Crackles imply the snapping open of airways or alveoli. Since larger airways open first as inhalation progresses from residual volume, early inspiratory crackles imply large airways disease while late inspiratory crackles either mean small airways problems (less than 2 mm) or poorly compliant alveoli walls such as seen in congestive heart failure, pulmonary fibrosis, or other interstitial pulmonary processes.
Gurgles suggest fluid in the airways. This may be produced by excessive serous secretion in alveolar cell carcinoma, infected purulent secretion of acute or chronic bronchitis or bronchiectasis, or transudated fluid entering the airways from the alveoli as occurs in pulmonary edema.
Chest CT
Thoracic CT; CT scan – lungs; CT scan – chest
A chest CT (computed tomography) scan is an imaging method that uses x-rays to create cross-sectional pictures of the chest and upper abdomen.
How the Test is Performed
The test is done in the following way:
- You’ll likely be asked to change into a hospital gown.
- You lie on a narrow table that slides into the center of the scanner. Once you are inside the scanner, the machine’s x-ray beam rotates around you.
- You must be still during the exam because movement causes blurred images. You may be told to hold your breath for short period of time.
The complete scan takes 30 seconds to a few minutes.
Certain CT scans require a special dye, called contrast, to be delivered into the body before the test starts. Contrast highlights specific areas inside the body and creates a clearer image. If your doctor requests a CT scan with intravenous contrast, you will be given it through a vein (IV) in your arm or hand. A blood test to measure your kidney function may be done before the test. This test is to make sure your kidneys are healthy enough to filter the contrast.
You may be given medicine to help you relax during the test.
How to Prepare for the Test
Some people have allergies to IV contrast and may need to take medicine before their test to safely receive this substance.
Contrast can be given in several ways, depending on the type of CT being performed.
- It may be delivered through a vein (IV) in your hand or forearm.
- It may be given through the rectum using an enema.
- You might drink the contrast before your scan. When you actually drink the contrast depends on the type of exam being done. The contrast liquid may taste chalky, although some are flavored to make them taste a little better. The contrast eventually passes out of your body through your stool.
If contrast is used, you may also be asked not to eat or drink anything for 4 to 6 hours before the test.
If you weigh more than 300 pounds (135 kilograms), have your health care provider contact the scanner operator before the exam. CT scanners have a weight limit. Too much weight can damage the scanner’s working parts.
Because it is hard for x-rays to pass through metal, you will be asked to remove jewelry.
How the Test will Feel
Some people may have discomfort from lying on the hard table.
Contrast given through an IV may cause a slight burning sensation, a metallic taste in the mouth, and a warm flushing of the body. These sensations are normal and usually go away within a few seconds.
There is no recovery time, unless you were given medicine to relax. After a CT scan, you can go back to your normal diet, activity, and medicines.
Why the Test is Performed
CT quickly creates detailed pictures of the body. The test may be used to get a better view of the structures inside the chest. A CT scan is one of the best ways of looking at soft tissues such as the heart and lungs.
A chest CT may be done:
- After a chest injury
- When a tumor or mass (clump of cells) is suspected, including a solitary pulmonary nodule seen on a chest x-ray
- To determine the size, shape, and position of organs in the chest and upper abdomen
- To look for bleeding or fluid collections in the lungs or other areas
- To look for infection or inflammation in the chest
- To look for blood clots in the lungs
- To look for scarring in the lungs
What Abnormal Results Mean
Thoracic CT may show many disorders of the heart, lungs, or chest area, including:
- A tear in the wall , an abnormal widening or ballooning , or narrowing of the major artery carrying blood out of the heart (aorta)
- Other abnormal changes of the major blood vessels in the lungs or chest
- Buildup of blood or fluid around the heart
- Lung cancer or cancer that has spread to the lungs from elsewhere in the body
- Collection of fluid around the lungs (pleural effusion)
- Damage to, and widening of the large airways of the lungs (bronchiectasis)
- Enlarged lymph nodes
- Lung disorders in which the lung tissues become inflamed and then damaged.
- Pneumonia
- Esophageal cancer
- Lymphoma in the chest
- Tumors, nodules, or cysts in the chest
Risks
CT scans and other x-rays are strictly monitored and controlled to make sure they use the least amount of radiation. CT scans use low levels of ionizing radiation, which has the potential to cause cancer and other defects. However, the risk from any one scan is small. The risk increases as many more studies are done.
In some cases, a CT scan may still be done if the benefits greatly outweigh the risks. For example, it can be more risky to not have the exam if your doctor thinks you might have cancer.
The most common type of contrast given into a vein contains iodine. If a person with an iodine allergy is given this type of contrast, nausea, sneezing, vomiting, itching, or hives may occur. In rare cases, the dye can cause a life-threatening allergic response called anaphylaxis. If you have any trouble breathing during the test, you should notify the scanner operator immediately. Scanners come with an intercom and speakers, so the operator can hear you at all times.
In people with kidney problems, the dye may have harmful effects on the kidneys. In these situations, special steps may be taken to make the contrast dye safer to use.
Chest MRI
Nuclear magnetic resonance – chest; Magnetic resonance imaging – chest; NMR – chest; MRI of the thorax; Thoracic MRI
A chest MRI (magnetic resonance imaging) scan is an imaging test that uses powerful magnetic fields and radio waves to create pictures of the chest (thoracic area). It does not use radiation (x-rays).
How the Test is Performed
The test is done in the following way:
- You may be asked to wear a hospital gown or clothing without metal fasteners (such as sweatpants and a t-shirt). Certain types of metal can cause blurry images or be dangerous to have on in the scanner room.
- You lie on a narrow table, which slides into the large tunnel-shaped scanner.
- You must be still during the exam, because movement causes blurred images.
Some exams require a special dye called contrast. The dye is usually given before the test through a vein (IV) in your hand or forearm. The dye helps the radiologist see certain areas more clearly. A blood test to measure your kidney function may be done before the test. This is to make sure your kidneys are healthy enough to filter the contrast.
During the MRI, the person who operates the machine will watch you from another room. The test most often lasts 30 to 60 minutes, but it may take longer.
How to Prepare for the Test
You may be asked not to eat or drink anything for 4 to 6 hours before the scan.
Tell your doctor if you are claustrophobic (afraid of closed spaces). You may be given a medicine to help you feel sleepy and less anxious. Your doctor may suggest an “open” MRI, in which the machine is not as close to your body.
Before the test, tell your health care provider if you have:
- Brain aneurysm clips
- Artificial heart valves
- Heart defibrillator or pacemaker
- Inner ear (cochlear) implants
- Kidney disease or are on dialysis (you may not be able to receive contrast)
- Recently placed artificial joints
- Vascular stents
- Worked with sheet metal in the past (you may need tests to check for metal pieces in your eyes)
The MRI contains strong magnets, so metal objects are not allowed into the room with the MRI scanner. This is because there is a risk that they will be drawn from your body toward the scanner. Examples of metal objects you will need to remove are:
- Pens, pocket knives, and eyeglasses
- Items such as jewelry, watches, credit cards, and hearing aids
- Pins, hairpins, and metal zippers
- Removable dental work
How the Test will Feel
An MRI exam causes no pain. If you have trouble lying still or are very nervous, you may be given medicine to relax you. Too much movement can blur MRI images and cause errors when the doctor looks at the images.
The table may be hard or cold, but you can ask for a blanket or pillow. The machine produces loud thumping and humming noises when turned on. You can wear ear plugs to help reduce the noise.
An intercom in the room allows you to speak to someone at any time. Some MRIs have televisions and special headphones that you can use to help the time pass.
There is no recovery time, unless you were given a medicine to relax. After an MRI scan, you can resume your normal diet, activity, and medicines.
Why the Test is Performed
A chest MRI provides detailed pictures of tissues within the chest area.
A chest MRI may be done to:
- Provide an alternative to angiography , or avoid repeated exposure to radiation
- Clarify findings from earlier x-rays or CT scans
- Diagnose abnormal growths in the chest
- Evaluate blood flow
- Show lymph nodes and blood vessels
- Show the structures of the chest from many angles
- See if cancer in the chest has spread to other areas of the body (this is called staging — it helps guide future treatment and follow-up, and gives you an idea of what to expect in the future)
- Detect tumors
Normal Results
A normal result means your chest area appears normal.
What Abnormal Results Mean
An abnormal chest MRI may be due to:
- A tear in the wall , an abnormal widening or ballooning , or narrowing of the major artery carrying blood out of the heart (aorta)
- Other abnormal changes of the major blood vessels in the lungs or chest
- Buildup of blood or fluid around the heart or the lungs
- Lung cancer or cancer that has spread to the lungs from elsewhere in the body
- Cancer or tumors of the heart
- Cancer or tumors of the chest , such as a thymus tumor
- Disease in which the heart muscle becomes weakened, stretched, or has another structural problem ( cardiomyopathy )
- Collection of fluid around the lungs (pleural effusion)
- Damage to, and widening of the large airways of the lungs (bronchiectasis)
- Enlarged lymph nodes
- Infection of the heart tissue or heart valve
- Esophageal cancer
- Lymphoma in the chest
- Birth defects of the heart
- Tumors, nodules, or cysts in the chest
Risks
MRI uses no radiation. To date, no side effects from the magnetic fields and radio waves have been reported.
The most common type of contrast (dye) used is gadolinium. It is very safe. Allergic reactions to the substance rarely occur. However, gadolinium can be harmful to people with kidney problems who need dialysis. If you have kidney problems, tell your provider before the test.
The strong magnetic fields created during an MRI can cause heart pacemakers and other implants not to work as well. It can also cause a piece of metal inside your body to move or shift.
Considerations
Currently, MRI is not considered a valuable tool for spotting or monitoring slight changes in lung tissue. The lungs contain mostly air and are hard to imagine. CT scan tends to be better for monitoring these changes.
Disadvantages of MRI include:
- High cost
- The long length of the scan
- Sensitivity to movement
Chest Nuclear stress test
Sestamibi stress test; MIBI stress test; Myocardial perfusion scintigraphy; Dobutamine stress test; Persantine stress test; Thallium stress test; Stress test – nuclear; Adenosine stress test; Regadenoson stress test; CAD – nuclear stress; Coronary artery disease – nuclear stress; Angina – nuclear stress; Chest pain – nuclear stress
The thallium stress test is a nuclear imaging method that shows how well blood flows into the heart muscle, both at rest and during activity.
How the Test is Performed
This test is done at a medical center or health care provider’s office. It is done in stages:
You will have an intravenous (IV) line started.
- A radioactive substance, such as thallium or sestamibi, will be injected into one of your veins.
- You will lie down and wait for between 15 and 45 minutes.
- A special camera will scan your heart and create pictures to show how the substance has traveled through your blood and into your heart.
Most people will then walk on a treadmill (or pedal on an exercise machine).
- After the treadmill starts moving slowly, you will be asked to walk (or pedal) faster and on an incline.
- If you are not able to exercise, you may be given a medicine called a vasodilator. This drug widens (dilates) your heart arteries.
- In other cases, you may get a medicine (dobutamine) that will make your heart beat faster and harder, similar to when you exercise.
Your blood pressure and heart rhythm ( ECG ) will be watched throughout the test.
When your heart is working as hard as it can, a radioactive substance is again injected into one of your veins.
- You will wait for 15 to 45 minutes.
- Again, the special camera will scan your heart and create pictures.
- You may be allowed to get up from the table or chair and have a snack or drink.
Your provider will compare the 1st and 2nd set of pictures using a computer. This can help detect if you have heart disease or if your heart disease is becoming worse.
How to Prepare for the Test
You should wear comfortable clothes and shoes with non-skid soles. You may be asked not to eat or drink after midnight. You will be allowed to have a few sips of water if you need to take medicines.
You will need to avoid caffeine for 24 hours before the test. This includes:
- Tea and coffee
- All sodas, even ones that are labeled caffeine-free
- Chocolates, and certain pain relievers that contain caffeine
Many medicines can interfere with blood test results.
- Your provider will tell you if you need to stop taking any medicines before you have this test.
- DO NOT stop or change your medicines without talking to your doctor first.
How the Test will Feel
During the test, some people feel:
- Chest pain
- Fatigue
- Muscle cramps in the legs or feet
- Shortness of breath
If you are given the vasodilator drug, you may feel a sting as the medicine is injected. This is followed by a feeling of warmth. Some people also have a headache, nausea, and a feeling that their heart is racing.
If you are given medicine to make your heart beat stronger and faster (dobutamine), you may have a headache, nausea, or your heart may pound faster and more strongly.
Rarely, during the test people experience:
- Chest discomfort
- Dizziness
- Palpitations
- Shortness of breath
If any of these symptoms occur during your test, tell the person performing the test right away.
Why the Test is Performed
The test is done to see if your heart muscle is getting enough blood flow and oxygen when it is working hard (under stress).
Your provider may order this test to find out:
- How well a treatment (medicines, angioplasty, or heart surgery) is working
- If you are at high risk for heart disease or complications
- If you are planning to start an exercise program or have surgery
- The cause of new chest pain or worsening angina
- What you can expect after you have had a heart attack
The results of a nuclear stress test can help:
- Determine how well your heart is pumping
- Determine the proper treatment for coronary heart disease
- Diagnose coronary artery disease
- See whether your heart is too large
Normal Results
A normal test most often means that you were able to exercise as long as or longer than most people of your age and gender. You also did not have symptoms or changes in blood pressure, your ECG or the images of your heart that caused concern.
A normal result means blood flow through the coronary arteries is probably normal.
The meaning of your test results depends on the reason for the test, your age, and your history of heart and other medical problems.
What Abnormal Results Mean
Abnormal results may be due to:
- Reduced blood flow to a part of the heart. The most likely cause is a narrowing or blockage of one or more of the arteries that supply your heart muscle.
- Scarring of the heart muscle due to a previous heart attack.
After the test you may need:
- Angioplasty and stent placement
- Changes in your heart medicines
- Coronary angiography
- Heart bypass surgery
Risks
Complications are rare, but may include:
- Arrhythmias
- Increased angina pain during the test
- Breathing problems or asthma-like reactions
- Extreme swings in blood pressure
- Skin rashes
Your provider will explain the risks before the test.
Considerations
In some cases, other organs and structures can cause false-positive results. However, special steps can be taken to avoid this problem.
You may need additional tests, such as cardiac catheterization, depending on your test results.
Chest Stress echocardiography
Echocardiography stress test; Stress test – echocardiography; CAD – stress echocardiography; Coronary artery disease – stress echocardiography; Chest pain – stress echocardiography; Angina – stress echocardiography; Heart disease – stress echocardiography
Stress echocardiography is a test that uses ultrasound imaging to show how well your heart muscle is working to pump blood to your body. It is most often used to detect a decrease in blood flow to the heart from narrowing in the coronary arteries .
How the Test is Performed
This test is done at a medical center or health care provider’s office.
A resting echocardiogram will be done first. While you lie on your left side with your left arm out, a small device called a transducer is held against your chest. A special gel is used to help the ultrasound waves get to your heart.
Most people will walk on a treadmill (or pedal on an exercise bicycle). Slowly (about every 3 minutes), you will be asked to walk (or pedal) faster and on an incline. It is like being asked to walk fast or jog up a hill.
In most cases, you will need to walk or pedal for around 5 to 15 minutes, depending on your level of fitness and your age. Your doctor will ask you to stop:
- When your heart is beating at the target rate
- When you are too tired to continue
- If you are having chest pain or a change in your blood pressure that worries the provider administering the test
If you are not able to exercise, you will get a drug such as dobutamine through a vein (intravenous line). This medicine will make your heart beat faster and harder, similar to when you exercise.
Your blood pressure and heart rhythm (ECG) will be monitored throughout the procedure.
More echocardiogram images will be taken while your heart rate is increasing, or when it reaches its peak. The images will show whether any parts of the heart muscle do not work as well when your heart rate increases. This is a sign that part of the heart may not be getting enough blood or oxygen because of narrowed or blocked arteries.
How to Prepare for the Test
Ask your provider if you should take any of your routine medicines on the day of the test. Some medicines may interfere with test results. Never stop taking any medicine without first talking to your doctor.
It is important to tell your doctor if you have taken any of the following medicines within the past 24 hours (1 day):
- Sildenafil citrate (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
DO NOT eat or drink for at least 3 hours before the test.
Wear loose, comfortable clothing. You will be asked to sign a consent form before the test.
How the Test will Feel
Electrodes (conductive patches) will be placed on your chest, arms, and legs to record the heart’s activity.
The blood pressure cuff on your arm will be inflated every few minutes, producing a squeezing sensation that may feel tight.
Rarely, people feel chest discomfort, extra or skipped heartbeats, dizziness, headache, nausea or shortness of breath during the test.
Why the Test is Performed
The test is performed to see whether your heart muscle is getting enough blood flow and oxygen when it is working hard (under stress).
Your doctor may order this test if you:
- Have new symptoms of angina or chest pain
- Have angina that is getting worse
- Have recently had a heart attack
- Are going to have surgery or begin an exercise program, if you are at high risk for heart disease
- Have heart valve problems
The results of this stress test can help your provider:
- Determine how well a heart treatment is working and change your treatment, if needed
- Determine how well your heart is pumping
- Diagnose coronary artery disease
- See whether your heart is too large
Normal Results
A normal test will most often mean that you were able to exercise as long as or longer than most people of your age and gender. You also did not have symptoms or concerning changes in blood pressure and your ECG. Your heart pictures show that all parts of your heart respond to increased stress by pumping harder.
A normal result means that blood flow through the coronary arteries is probably normal.
The meaning of your test results depends on the reason for the test, your age, and your history of heart and other medical problems.
What Abnormal Results Mean
Abnormal results may be due to:
- Reduced blood flow to a part of the heart. The most likely cause is a narrowing or blockage of the arteries that supply your heart muscle.
- Scarring of the heart muscle due to a past heart attack.
After the test you may need:
- Angioplasty and stent placement
- Changes in your heart medicines
- Coronary angiography
- Heart bypass surgery
Risks
The risks are very low. Health care professionals will monitor you during the entire procedure.
Rare complications include:
- Abnormal heart rhythm
- Fainting (syncope)
- Heart attack
Chest Exercise stress test
Exercise ECG; ECG – exercise treadmill; EKG – exercise treadmill; Stress ECG; Exercise electrocardiography; Stress test – exercise treadmill; CAD – treadmill; Coronary artery disease – treadmill; Chest pain – treadmill; Angina – treadmill; Heart disease – treadmill
An exercise stress test is used to measure the effect of exercise on your heart.
How the Test is Performed
This test is done at a medical center or health care provider’s office.
The technician will place 10 flat, sticky patches called electrodes on your chest. These patches are attached to an ECG monitor that follows the electrical activity of your heart during the test.
You will walk on a treadmill or pedal on an exercise bicycle. Slowly (about every 3 minutes), you will be asked to walk (or pedal) faster and on an incline or with more resistance. It is like walking fast or jogging up a hill.
While you exercise, the activity of your heart is measured with an electrocardiogram ( ECG ). Your blood pressure readings are also taken.
The test continues until:
- You reach a target heart rate .
- You develop chest pain or a change in your blood pressure that is concerning.
- ECG changes suggest that your heart muscle is not getting enough oxygen.
- You are too tired or have other symptoms, such as leg pain, that keep you from continuing.
You will be monitored for 10 to 15 minutes after exercising, or until your heart rate returns to baseline. The total time of the test is around 60 minutes.
How to Prepare for the Test
Wear comfortable shoes and loose clothing to allow you to exercise.
Ask your provider if you should take any of your regular medicines on the day of the test. Some medicines may interfere with test results. Never stop taking any medicine without first talking to your doctor.
Tell your doctor if you are taking sildenafil citrate (Viagra), tadalafil (Cialis), or vardenafil (Levitra) and have taken a dose within the past 24 to 48 hours.
You must not eat, smoke, or drink beverages containing caffeine or alcohol for 3 hours (or more) before the test. In most cases, you will be asked to avoid caffeine for 24 hours before the test. This includes:
- Tea and coffee
- All sodas, even ones that are labeled caffeine-free
- Chocolates
- Certain pain relievers that contain caffeine
How the Test will Feel
Electrodes (conductive patches) will be placed on your chest to record the heart’s activity. The preparation of the electrode sites on your chest may produce a mild burning or stinging sensation.
The blood pressure cuff on your arm will be inflated every few minutes. This produces a squeezing sensation that may feel tight. Baseline measurements of heart rate and blood pressure will be taken before exercise starts.
You will start walking on a treadmill or pedaling a stationary bicycle. The pace and incline of the treadmill (or the pedaling resistance) will slowly be increased.
Sometimes, people experience some of the following symptoms during the test:
- Chest discomfort
- Dizziness
- Palpitations
- Shortness of breath
Why the Test is Performed
Reasons why an exercise stress test may be performed include:
- You are having chest pain (to check for coronary artery disease, narrowing of the arteries that feed the heart muscle).
- Your angina is getting worse or is happening more often.
- You have had a heart attack.
- You have had angioplasty or heart bypass surgery .
- You are going to start an exercise program and you have heart disease or certain risk factors, such as diabetes.
- To identify heart rhythm changes that may occur during exercise.
- To further test for a heart valve problem (such as aortic valve or mitral valve stenosis ).
There may be other reasons why your provider asks for this test.
Normal Results
A normal test will most often mean that you were able to exercise as long as or longer than most people of your age and gender. You also did not have symptoms or concerning changes in blood pressure or your ECG.
The meaning of your test results depends on the reason for the test, your age, and your history of heart and other medical problems.
It may be hard to interpret the results of an exercise-only stress test in some people.
What Abnormal Results Mean
Abnormal results may be due to:
- Abnormal heart rhythms during exercise
- Changes in your ECG that may mean there is a blockage in the arteries that supply your heart ( coronary artery disease )
When you have an abnormal exercise stress test, you may have other tests performed on your heart such as:
- Cardiac catheterization
- Nuclear stress test
- Stress echocardiography
Risks
Stress tests are generally safe. Some people may have chest pain or may faint or collapse. A heart attack or dangerous irregular heart rhythm is rare.
People who are more likely to have such complications are often already known to have heart problems, so they are not given this test.
Chest /Lung PET scan
Chest PET scan; Lung positron emission tomography; PET – chest; PET – lung; PET – tumor imaging; PET/CT – lung; Solitary pulmonary nodule – PET
A lung positron emission tomography ( PET ) scan is an imaging test. It uses a radioactive substance (called a tracer) to look for disease in the lungs such as lung cancer .
Unlike magnetic resonance imaging ( MRI ) and computed tomography ( CT ) scans, which reveal the structure of the lungs, a PET scan shows how well the lungs and their tissues are working.
How the Test is Performed
A PET scan requires a small amount of tracer. The tracer is given through a vein (IV), usually on the inside of your elbow. It travels through your blood and collects in organs and tissues. The tracer helps the doctor (radiologist) see certain areas or diseases more clearly.
You will need to wait nearby as the tracer is absorbed by your body. This usually takes about 1 hour.
Then, you will lie on a narrow table, which slides into a large tunnel-shaped scanner. The PET scanner detects signals from the tracer. A computer changes the results into 3-D pictures. The images are displayed on a monitor for your doctor to read.
You must lie still during test. Too much movement can blur images and cause errors.
The test takes about 90 minutes.
Most PET scans are now performed along with a CT scan. This is because the combined information from each scan provides a more complete understanding of the health problem. This combination scan is called a PET/CT.
How to Prepare for the Test
You may be asked not to eat anything for 4 to 6 hours before the scan. You will be able to drink water.
Tell your health care provider if:
- You are afraid of tight spaces (have claustrophobia). You may be given a medicine to help you relax and feel less anxious.
- You are pregnant or think you might be pregnant.
- You have any allergies to injected dye (contrast).
- You take insulin for diabetes. You will need special preparation.
Tell your provider about the medicines you are taking. These include ones bought without a prescription. Some medicines can interfere with the test results.
How the Test will Feel
You may feel a sharp sting when the needle containing the tracer is placed into your vein.
A PET scan causes no pain. The table may be hard or cold, but you can request a blanket or pillow.
An intercom in the room allows you to speak to someone at any time.
There is no recovery time, unless you were given a medicine to relax.
Why the Test is Performed
This test may be done to:
- Help look for lung cancer, when other imaging tests do not give a clear picture
- See if lung cancer has spread to other areas of the lungs or body, when deciding on the best treatment
- Help determine if a growth in the lungs (seen on a CT scan) is cancerous or not
- Determine how well cancer treatment is working
Normal Results
A normal result means the scan did not show any problems in the size, shape, or function of the lungs.
What Abnormal Results Mean
Abnormal results may be due to:
- Lung cancer or cancer of another area of the body that has spread to the lungs
- Infection
- Inflammation of the lungs due to other causes
Blood sugar or insulin level may affect the test results in people with diabetes.
Risks
The amount of radiation used in a PET scan is low. It is about the same amount of radiation as in most CT scans. Also, the radiation does not last for very long in your body.
Women who are pregnant or are breastfeeding should let their doctor know before having this test. Infants and babies developing in the womb are more sensitive to the effects of radiation because their organs are still growing.
It is possible, although very unlikely, to have an allergic reaction to the radioactive substance. Some people have pain, redness, or swelling at the injection site. This soon goes away.
Chest x-ray
Chest radiography; Serial chest x-ray; X-ray – chest
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
How the Test is Performed
You stand in front of the x-ray machine. You will be told to hold your breath when the x-ray is taken.
Two images are usually taken. You will first need to stand facing the machine, and then sideways.
How to Prepare for the Test
Tell the health care provider if you are pregnant. Chest x-rays are generally not done during the first 6 months of pregnancy.
How the Test will Feel
There is no discomfort. The film plate may feel cold.
Why the Test is Performed
Your doctor may order a chest x-ray if you have any of the following symptoms:
- A persistent cough
- Chest pain from a chest injury (with a possible rib fracture or lung complication) or from heart problems
- Coughing up blood
- Difficulty breathing
- Fever
It may also be done if you have signs of tuberculosis , lung cancer , or other chest or lung diseases .
A serial chest x-ray is one that is repeated. It may be done to monitor changes found on a past chest x-ray.
What Abnormal Results Mean
Abnormal results may be due to many things, including:
In the lungs:
- Collapsed lung
- Collection of fluid around the lung
- Lung tumor (noncancerous or cancerous)
- Malformation of the blood vessels
- Pneumonia
- Scarring of lung tissue
- Tuberculosis
In the heart:
- Problems with the size or shape of the heart
- Problems with the position and shape of the large arteries
- Evidence of heart failure
In the bones:
- Fractures or other problems of the ribs and spine
- Osteoporosis
Risks
There is low radiation exposure. X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most experts feel that the benefits outweigh the risks. Pregnant women and children are more sensitive to the risks of x-rays.
