BLOOD TESTS

Blood Tests are done in the surgery by appointment.
Our samples are sent to St James Hospital and results are returned electronically, directly into your patient record. Once your results have been reviewed by one of the doctors, you will be contacted by us with your blood test results.

24H AMBULATORY BLOOD PRESSURE MONITOR (ABPM)

Ambulatory Blood Pressure Monitoring (ABPM) is when your blood pressure is being measured as you move around, living your normal daily life. It is normally carried over 24 hours. It uses a small digital blood pressure machine that is attached to a belt around your body and which is connected to a cuff around your upper arm. It small enough that you can go about your normal daily life and even sleep with it on.

Why might I need a 24-hour monitor?

By measuring your blood pressure at regular intervals over 24 hours, we are able to get clear pictures of how your blood pressure changes throughout the day. There are a number of reasons why we at E&S Doctors might suggest this test:

• To find out if your high blood pressure readings in the clinic are much higher than they are away from the clinic (called the “white coat effect”).

• To see how well your medicines are working, to make sure they are controlling your blood pressure through the day.

• To see if your blood pressure stays high at night. If this is the case, they may need to change or adjust your medicines.

What happens during 24-hour blood pressure monitoring?

The machine is fitted to our premises at E&S Doctors. A 24-hour blood pressure measurement is just the same as a normal blood pressure check: a digital machine takes your blood pressure by inflating a cuff around your upper arm and then slowly releasing the pressure. The machine is small enough to be worn on a belt on your waist while the cuff stays on your upper arm for the full 24 hours.

The machine then takes blood pressure readings at regular intervals throughout the day: usually, every 15-30 minutes during the daytime and 30-60 minutes at night. You will need to keep the monitor on through the night – you could put the machine under the pillow or on the bed while you sleep.

Because the test is being carried out to find out what your normal daily blood pressure is, it is important to carry on with your normal routine and do all the things you would normally do. The only things you should avoid doing for the day are swimming and having a bath or shower.

At the end of the 24 hours, you can remove the machine and cuff and give it back to us at our premises. The machine will have stored all your readings and these will then be analysed.

What do I need to do during 24-hour blood pressure monitoring?

To allow the machine to work properly, it is important to make sure that the tube to the machine is not twisted or bent. Also, just before the machine is about to take a reading, it will beep. When this happens you should:

• sit down, if possible

• keep the cuff at the same level as your heart

• keep your arm steady.

You will also be asked to keep a diary of what you were doing just before the reading was taken, what time you went to bed and got up and if and when you took medications. Some people find 24-hour ABPM distracting and uncomfortable: if you feel like this when the readings are being taken, speak with us as it may affect your reading.

ECG

An ECG is a recording of the electrical activity in the heart. Your doctor may need to refer you for various reasons. A modern ECG machine is available in the practice.

24H HOLTER MONITOR

A Holter monitor is a machine that continuously records the heart’s rhythms. The monitor is worn for 24 to 48 hours during normal activity.

How the Test is Performed

Electrodes (small conducting patches) are stuck onto your chest. These are attached by wires to a small recording monitor. You carry the Holter monitor in a pocket or pouch
worn around your neck or waist. The monitor runs on batteries.

• While you wear the monitor, it records your heart’s electrical activity. Keep a diary of what activities you do while wearing the monitor, and how you feel.
• After 24 hours, you will return the monitor to us. We will look at the records and see if there have been any abnormal heart rhythms.

How To prepare for the test:

You DO NOT need to prepare for the test. Our Nurse will start the monitor. You’ll be told how to replace the electrodes if they fall off or get loose. Tell us if you are allergic to any tape or other adhesives. Make sure you shower or bathe before you start the test. You will not be able to do so while you are wearing a Holter monitor.

How the test will feel

This is a painless test. However, some people may need to have their chest shaved so the electrodes can stick. You must keep the monitor close to your body. This may make it hard for you to sleep.

Why the test is performed

Holter monitoring is used to determine how the heart responds to normal activity. The monitor may also be used:

• After a heart attack

• To diagnose heart rhythm problems that may be causing symptoms such as palpitations or syncope (passing out/fainting). When starting a new heart medicine Heart rhythms which may be recorded include:

• Atrial fibrillation or flutter
• Multifocal atrial tachycardia
• Paroxysmal supraventricular tachycardia
• Slow heart rate (bradycardia)
• Ventricular tachycardia

SPIROMETRY TEST

Spirometry is a simple test used to help diagnose and monitor certain lung conditions by measuring how much air you can breathe out in one forced breath. It’s carried out using a device called a spirometer, which is a small machine attached by a cable to a mouthpiece.

Spirometry may be performed by a nurse or doctor at your GP surgery, or it may be carried out during a short visit to a hospital or clinic.

Why spirometry is carried out

Spirometry can be used to help diagnose a lung condition if you have symptoms of a problem, or your doctor feels you’re at an increased risk of developing a particular lung condition.
For example, it may be recommended if you have a persistent cough or breathlessness, or if you’re over 35 and smoke.

Conditions that can be picked up and monitored using spirometry include:

• Asthma – a long-term condition in which the airways become periodically inflamed (swollen) and narrowed.

• Chronic obstructive pulmonary disease (COPD) – a group of lung conditions where the airways become narrowed.

• Cystic fibrosis – a genetic condition in which the lungs and digestive system become clogged with thick, sticky mucus.

• Pulmonary fibrosis – scarring of the lungs.

If you’ve already been diagnosed with one of these conditions, spirometry may be carried out to check the severity of the condition or see how you’re responding to treatment.

Spirometry is also a standard test for people who may be being considered for surgery, or to check the general health of people who have other conditions such as rheumatoid arthritis.

Preparing for the test

You’ll be told about anything you need to do to prepare for the test.

If you use bronchodilator medication (medicines, usually inhaled, that help relax and widen your airways), you may need to stop using it beforehand.

You should also avoid smoking for 24 hours before the test, and avoid drinking alcohol, strenuous exercise or eating large meals for a few hours beforehand.

It’s best to wear loose, comfortable clothing on the day of the test.

What happens during a spirometry test

You’ll be seated during the test and a soft clip will be placed on your nose to stop air escaping from it. The tester will explain what you need to do and you may be asked to have a few practice attempts first.

When you’re ready for the test, you’ll be asked to:

• Inhale fully, so your lungs are completely filled with air.

• Close your lips tightly around the mouthpiece.

• Exhale as quickly and forcefully as you can, making sure you empty your lungs fully.

This will normally need to be repeated at least three times to ensure a reliable result. In some cases, the test may need to be repeated around 15 minutes after taking some
inhaled bronchodilator medication. This can show if you have a lung condition that responds to these medications.

Overall, your appointment should last around 30-90 minutes. You’ll be able to go home soon after the tests have finished and can return to your normal activities.

Your results

The person carrying out the test won't usually be able to give you your results immediately. The results will need to be looked at by a specialist first and will be sent to the doctor who referred you for the test, who will discuss them with you a few days later.

A spirometer measures the amount of air you can breathe out in one second and the total volume of air you can exhale in one forced breath. These measurements will be compared to a normal result for someone of your age, height and sex, which will help show if your lungs aren't working properly.

The measurements will also show whether any problem with your lungs is ‘obstructive’, ‘restrictive’, or a combination of the two.

• An obstructive airways disease is where your ability to breathe out quickly is affected by narrowing of the airways, but the amount of air you can hold in your lungs is normal – such as in asthma or COPD.

• A restrictive lung disease is where the amount of air you can breathe in is reduced because your lungs are unable to fully expand – such as in pulmonary fibrosis.

Are there any risks or side effects?

Spirometry is a straightforward test and is generally considered very safe. Some people may feel dizzy, faint, shaky, sick or tired for a short period afterwards.

Most people are able to have a spirometry test safely. However, the test increases the pressure inside your head, chest, stomach, and eyes as you breathe out, so it may need to be delayed or avoided if you have a condition that could be made worse by this. For example, spirometry may not be safe if you have, or have recently had, unstable angina, a heart attack, uncontrolled high blood pressure, or an operation to your head, chest, stomach or eyes.