Cardiac Stress Test Using Medicine with One and Two Day Imaging

What is a cardiac stress test using medicine?
How do you get ready for the test?
What is done during the test?
What should you do after the test?
How do you get ready for the test?
What if you cannot make your testing appointment?

What is a cardiac stress test using medicine?

Medicine will be used to stress your heart instead of exercise. This medicine will increase your heart rate and/or open up (dilate) the heart arteries. This test may show evidence of blockages in the heart arteries when the heart is stressed. You can be scheduled  for one of the following:

• Dobutamine-Atropine Stress Test with Echocardiography: This test uses an echocardiogram to get images of your heart. An echocardiogram is an ultrasound of the heart done with a special probe that is applied to the chest over the heart. A medication is given to make the heart beat harder and faster. Ultrasound images are taken of the heart before the medication is given, during the medication and when the heart rate is highest. The cardiologist looks for EKG changes and for abnormal movements of the heart chambers walls during this test.
  
  This test is done in one visit.
  

• Dobutamine-Atropine Nuclear Stress Test: A nuclear imaging camera is used to view the blood flow to the heart at rest and with stress. In order for the Nuclear camera to image your heart a very small amount of a radioactive tracer is given in an IV. In one visit you will come in for resting images which require an injection of radioactive tracer, a waiting period, and then a 14 minute scan. On the visit that you come in for stress images, you will come to the Cardiac Testing Lab where a medication to make the heart beat harder and faster and another dose of radioactive tracer is given. After the stress portion of the test is completed you are placed under the Nuclear camera for the stress images. At this time the staff may instruct you to take any medicines you may have held for the test.
  
  This generally is a 2 day test requiring about 1.5 - 2 hours each visit.
  

• Adenosine or Dipyridamole Nuclear Stress Test: A nuclear imaging camera is used to view the blood flow to the heart at rest and with stress. In order for the nuclear camera to image your heart a very small amount of a radioactive tracer is given in an IV.  In one visit you will come in for resting images which require an injection of radioactive tracer, a waiting period, and then a 14 minute scan. On the visit that you come in for the stress images, you will come to the Cardiac Testing Lab where a medication to open up (dilate) your heart arteries and another dose of radioactive tracer is given. Adenosine to dilate arteries is a natural enzyme occurring in the body. You will have at least a 30 to 45 minute wait before being placed under the nuclear camera for the stress images. At this time the staff may instruct you to take any medicines you may have held for the test. You will be offered water, juice and crackers.
  
  This generally is a 2 day test requiring about 1½- 2 hours each visit.

How do you get ready for the test?

DO wear clothing you can remove from the waist up.

DO arrive 30 minutes before the test is scheduled. Check in at admissions. You will be instructed to go to either Radiology or Cardiology. The staff will ask you questions and start an IV in your arm.

DO drink extra water before the test

DO let the Cardiology Staff know if you are taking theophylline or dipyridamole (Persantine) products.  They may interfere with the test medicine. They may or may not be able to be held*.

DO take all your other scheduled medications as usual.

DO bring all of your medications, including inhalers, with you. We may have you take your rescue inhaler if needed, We also may have you take some of the medicines you have had to hold for the test.

DO NOT eat anything five hours before the test. You may have water or juice.

DO NOT do strenuous exercise the day of the test

DO NOT take any caffeine or decaffeinated products for at least 24 hours before the stress portion of the test.  Caffeine or decaffeinated products include:

• Regular and caffeine-free sodas

• Coffee, including decaf

• Tea, including herbal or decaf

• Chocolate products

• Some Medications  (Fioricet, Norgesic, Synalgos-DC, Anacin, NoDoz, Aggrenox, Fiorinal, Norgesic Forte, Wigraine, Excedrin, Vivarin)

The medications used to do the stress test may not work if you have caffeine or decaffeinated products, or theophylline or dipyridamole and you may get an inaccurate test result. If you forget & do have caffeine the day before the test, please call the phone triage nurse at 303-398-1930.  Ask to speak to someone from Cardiology regarding your stress test.

*Other medications you may be asked to hold before the test are beta blockers, calcium channel blockers or nitrate products. Check with the cardiology staff. If you do not eat, you may have to hold your diabetes medicines, especially the morning Insulin. You know yourself best to make an appropriate decision regarding your diabetes medicines. Call your doctor or the Cardiology department if you need help deciding what to do with your diabetic medicines.

What is done during the test?

Nuclear Stress Test
This test generally will be done on two different days so you will either go to Radiology or Cardiology

Cardiology – Cardiac Lab
The staff will explain the test to you before you start. Ask questions if you don’t understand. Before the test you will need to remove all clothing and jewelry from the waist up and you will be given a hospital gown to wear.

The staff will start an IV. You will feel a prick when the IV is started. The IV will be used to give you the radioactive tracer and the medicine to stress the heart. Injecting the tracer or the heart medicine does not hurt.

For the stress part of the test you will be lying down. EKG leads will be placed on your chest and you will be closely monitored by the Cardiac Testing Staff. The medicine will be infused over a period of minutes.  The medicine can make you feel like you exercised and may produce symptoms of chest discomfort, tingling, lightheadedness, nausea, headache and shortness of breath. These can be normal reactions to the medicine and does not mean you are having a heart problem. The staff will coach you through this and may be able to give you reversal medicine for symptoms.

Radiology-Nuclear Lab
You will visit the nuclear lab twice, once for resting images and once for stress images following testing in the Cardiac Lab. Each visit an IV will be started by the staff.

When the nuclear images are obtained, you will lie still on a table under a camera. You will be instructed to raise your arms over your head. It is important to lie still while the images are being obtained. The technologist will be available at all times. The camera is not a tube and generally people are not claustrophic, however, if you are very sensitive to enclosed areas let us know.

What should you do after the test?

After the resting portion you may return to normal activities and diet.

After the stress portion you may return to normal activities but avoid strenuous exercise that day. You may resume your normal diet and fluids. The Cardiac Staff will give you special instructions depending on what medicines they may have used. You may take any medicines that were held for the test.

How do you get ready for the test?

You will check in at Admissions and they will direct you where to go. Your appointment will start in either Radiology or Cardiology. Radiology is located in the basement of the May building. Cardiology is located in the Adult Clinic in the Smith building.

What if you cannot make your testing appointment?

Please inform us if you will be unable to make your appointments. The medicine used to do the test is very expensive and is prepared according to your specific body weight. The medicine may be prepared the afternoon before the test. If we do not know that you will not be here this expensive medicine may have to be wasted. Therefore, we are requesting that if you need to cancel your tests that you do so at least less than 24 hours or more before the scheduled appointments.

IMPORTANT: If you do not cancel in this time frame or do not show up for the test we may bill you for the cost of the wasted medication.

Please notify us if you have to cancel the tests at least 24 hours before the appointments.  Call scheduling at 303-398-1355.

This information has been approved by Howard Weinberger, MD, and Barbara Lemer, MS, NP-C (January 2008).