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This week we respond to questions about stress tests and finger nails.

Dear HOUSE Calls,

My cardiologist scheduled me for a nuclear stress test. What is the difference between this and a regular stress test?

There are two different components to a stress test. There is the stress, and there is the heart evaluation of response to the stress. We prefer to use exercise for the stress. This might be on a treadmill or a bicycle and is usually done according to a protocol, or until development of symptoms such as EKG changes, blood pressure changes, or near maximal exercise capacity. If a patient cannot exercise, we can use a medicine to increase the heart rate and work load of the heart. This might be an important option for somebody with severe arthritis, deconditioning, or underlying heart or lung disease.

Then there is the evaluation part of the test, which requires some idea of how the heart is responding to the stress. This can be done with ekg monitoring, nuclear images, or ultrasound images. All three of these have their pluses and minuses.The nuclear images and the ultrasound are somewhat more accurate but a lot more expensive. During the nuclear test, the patient receives an injection of a nuclear tracer that will be attracted to heart muscle during exercise. Images are taken of the heart at rest, then the heart is stressed (either by exercise or medicine) and then the images are taken again. Areas which show poor blood flow may be affected by coronary disease. Hopefully this helps clarify the differences.

In the end, none of these studies are perfect, and they are used to evaluate a patient’s risk and determine if a cardiac catheterization is warranted. Your doctor will recommend which test is best for you based on your symptoms and your risk of coronary disease.

Dear HOUSE Calls,

My nails are brittle and they tend to get white spots. Does this mean that I am vitamin deficient? Is there something I can do to make my nails stronger?

White spots are often a sign of minor trauma or hitting your nails. Both white spots and brittle nails can be caused by deficiency in trace minerals. There are a variety of other issues that may cause these nail changes, including genetic conditions, metabolic conditions, fungal nail infections, and picking at your nails. Psoriasis can also cause similar findings.

That is a tough question to answer without the benefit of touching and feeling your nails and skin. We would also like to know more about your general health before giving a diagnosis in print. If this is new, see your doctor sooner rather than later. If has been going on for awhile, you can probably ask at your next yearly exam. Good luck.

HOUSE Calls is a weekly column by Dr. Cristy Page, Dr. Adam Zolotor, and Dr. Adam Goldstein on behalf of YOUR HEALTH and the UNC Department of Family Medicine.

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