Medical Tests & Procedures Archive

These devices help you keep tabs on a key indicator of your cardiovascular health.

Of all the things you measure to assess your health, blood pressure certainly ranks among the most important. High blood pressure not only puts you at risk for a heart attack or a stroke, but also can damage your brain, eyes, and kidneys.

For some people with this common condition, checking blood pressure intermittently at the doctor's office may not be enough. Investing in a simple, inexpensive home blood pressure monitor often makes sense. It's especially helpful when you're starting a new medication or are taking several different ones and still working to reach your blood pressure goal.

Screening for lung and breast cancer may reveal information about the health of your heart's arteries.

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Screening tests for two of the most common forms of cancer involve detailed x-ray images of the chest. Growing evidence suggests that these tests — chest computed tomography (CT) scans and mammograms — may also offer clues about a person's risk of heart disease.

"Both doctors and their patients should be aware that the low-dose CT scans used to find lung cancer can also detect plaque in the arteries of the heart," says Dr. Ron Blankstein, a cardiovascular imaging specialist and preventive cardiologist at Harvard-affiliated Brigham and Women's Hospital. CT scans take a series of rapid-fire x-rays in seconds. Combined, the images allow doctors to "see" structures inside the body.

In most cases, a primary care doctor or chiropractor can help you resolve the problem.

Low back pain is one of the most common complaints on the planet. And you may wonder where to turn when you start experiencing some of those aches or twinges in the lower part of your back. Take heart. "In most cases, you won't need a specialist," says Dr. Robert Shmerling, a rheumatologist at Harvard-affiliated Beth Israel Deaconess Medical Center.

When pain strikes

There are many causes of low back pain. Some of the most common include an injury to a muscle or tendon (a strain), an injury to a back ligament (a sprain), and a herniated or "slipped" disc (when the soft material inside of a disc between spinal bones leaks and irritates nerves). Many of these issues will eventually resolve on their own.

Ask the doctor

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Q. I heard my cardiologist say to another doctor that I have a "full metal jacket." What does that mean?

A. Cardiologists use the term "full metal jacket" to refer to a long series of stents in one of the heart's three major arteries. Stents are tiny metal cylinders, often with drug coatings, that help prop open arteries to restore blood flow to the heart. They're placed inside arteries during an angioplasty, in which a doctor snakes a thin, flexible tube (catheter) through the blood vessels to a narrowed section. A deflated balloon at the tip of the catheter then inflates, pushing fatty plaque against the artery wall and expanding the stent.

Because many factors are involved, make sure your doctors talk to each other if you need an invasive test or procedure.

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Millions of people with cardiovascular disease take drugs that help prevent blood clots, which can lodge in a vessel and choke off part of the blood supply to a leg, a lung, or the brain. These potentially lifesaving medications, known generally as anticoagulants, include warfarin (Coumadin) and a class of drugs called non–vitamin K antagonist oral anticoagulants, or NOACs (see "Anti-clotting drugs: The old and the new").

However, if you're taking one of these drugs and need an invasive procedure — anything from a tooth extraction to a hip replacement — managing the risks can be tricky, says cardiologist Dr. Gregory Piazza, assistant professor of medicine at Harvard Medical School. "There's a higher-than-normal risk of bleeding during and after the procedure, because your blood doesn't clot as easily," he says.

In the journals

A common laser treatment may help people with a specific type of eye floater, according to a small study published online July 20, 2017, by JAMA Ophthalmology. Floaters are spots in your vision like black or gray specks, strings, flying bugs, or cobwebs. They become more prevalent with age and occur when the jelly-like substance inside the eyes becomes more liquid, shrinks, and separates from the back wall of the eye.

There are three treatments for floaters: observation, where a floater is monitored for changes (for instance, if it moves away from your central vision or the brain adapts and ignores it); vitrectomy surgery to remove the floater; and YAG vitreolysis, which vaporizes the floater with a laser.

A direct-to-consumer test can uncover risks for developing some diseases. But will it help you improve your health?

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What if you could take a test at home to predict your risk of getting certain diseases, like Alzheimer's or Parkinson's? It's a question you may face now that the FDA has given the green light to third-party direct-to-consumer (DTC) test kits that look for genetic risk information.

"Increasingly, people want to explore their own medical data," says Dr. Robert Green, a Harvard Medical School professor and geneticist at Harvard-affiliated Brigham and Women's Hospital, who studies the medical, behavioral, and economic outcomes associated with genomic medicine (for more about his work, visit www.genomes2people.org).

Ask the doctor

 Illustration by Scott Leighton

Q. I was recently admitted to the hospital with heart failure and received a heart ultrasound. The test report stated that my heart's pumping ability is normal. I don't understand. Was my diagnosis wrong, or is the test wrong?

A. If you were diagnosed with heart failure in the hospital, I'm presuming that you were admitted with symptoms such as shortness of breath, fatigue, and difficulty doing everyday activities. Other common symptoms include swelling in your legs and feet and trouble breathing at night.

The latest guidelines suggest you should have an engaged conversation with your doctor about PSA testing.

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An annual prostate-specific antigen (PSA) test to check for signs of possible prostate cancer sounds innocent enough, but new guidelines suggest the test offers few long-term benefits, and substantial possible harm.

The updated guidelines from the U.S. Preventive Services Task Force (USPSTF), published online April 11, 2017, by The Journal of the American Medical Association, reinforce the organization's 2012 conclusion that PSA screenings have only a small potential benefit for reducing the chance of dying of prostate cancer for men ages 55 to 69 — while exposing them to possible overtreatment and side effects from biopsies, radiation, and surgery.

Ask the doctor

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Q. I have a mechanical heart valve, so I'm taking warfarin. But the frequent blood tests and occasional dose changes are bothersome. When, if ever, will I be able to take one of the new blood thinners instead of warfarin? Off-label use of other drugs is not uncommon. Why isn't that an option in this case?

A. Your question is a good one, and it requires a two-part answer. When doctors prescribe drugs "off-label," that means they believe the drug will help you, even if it has not been FDA-approved specifically for your condition. Sometimes, subsequent research provides strong evidence to support a specific off-label use, which may lead to the drug's FDA approval for that condition. But sometimes, research shows the exact opposite: a medication that doctors assumed would be beneficial is, in fact, not helpful — and sometimes even harmful.