Nuclear as well as standard stress testing is available to diagnose abnormalities of blood flow to the heart muscle, evaluate physical conditioning, and other exertion induced symptoms. The nuclear technique can also provide information regarding any heart muscle weakness and also distinguish between normal heart muscle, live heart muscle with reduced blood flow, and damaged heart muscle.
Our practice uses many of the nuclear cardiology techniques to check for the presence of heart disease and to provide the best treatments for persons with established heart disease.
What is a Nuclear Stress Test?
It is a noninvasive test which helps determine whether or not you have coronary artery disease. Chest pain or shortness of breath may be an indication of blockage of the coronary arteries. These arteries supply the heart with blood and oxygen. A stress test is ordered to detect any significant coronary blockage by monitoring the electrocardiogram, blood pressure and then pictures are taken of the heart muscle during the test. Many blockages are silent and may not be detected unless a stress test is performed. The stress test may be given in two different ways. The first and most common is walking on a treadmill. The second uses medication which stresses the heart. In a nuclear stress test, the patient will be injected with a small amount of radioactive material while he or she is at rest, and again one minute before the patient finishes exercising. After each injection, scans are taken of the heart. These scans enable the physician to more accurately identify heart disease.
What Will Happen During the Test?
You will first be brought into an examination room. A brief history and physical will be done and an intravenous line will be inserted. A small dose of radioactive tracer will then be injected. Next, you will wait to be called for pictures to be taken of your heart. You will lie flat for approximately 12 minutes while the pictures are taken. Following an electrocardiogram, you will walk on a treadmill or receive intravenous medication which simulates exercise. At peak exercise, you will be injected with a radio pharmacological agent to take pictures of your heart. You will then rest, wait, and then be called for the last set of pictures on the camera.
Who Will Be There?
At first you will meet the medical assistant, followed by the nuclear technologist. The physician works very closely with both of these specially trained professionals. The test is interpreted by a cardiologist specially trained in nuclear procedures. As there are benefits to this test, there are also risks as with any medical procedure or test. Although stress testing is very safe, approximately 1/10,000 patients may experience heart attack, stroke, or abnormal heartbeats. All necessary precautions are taken to prevent and treat these events.
What is a Radioactive Tracer?
This means that you will be exposed to a small amount of radioactive material equivalent to a few x-rays. This has not been shown to be harmful in long-term studies. However, if you are of childbearing age, or nursing a child, it is crucial that you inform the nurse, physician or technologist.
Could I Be Allergic?
Allergic reactions to radioactive medications occur very rarely. It is important to know that the radioisotope is NOT a contrast or dye. Please inform the nurse of all allergies during your visit.
The total test takes approximately three to four hours to complete and is performed in multiple stages. To ensure the highest quality of testing, all instructions must be followed.
Preparation for the Test
- Fasting is required. You may not eat anything after midnight of the previous day. However, if your
- Drink plenty of water and make sure you are well hydrated before the test.
- Do not smoke or use any tobacco or nicotine products 12 hours prior to the test.
- No caffeine 24 hours prior to the test. This includes coffee, tea, chocolate, soda, and
- decaffeinated products.
- Wear a comfortable, two-piece outfit and athletic or rubber-soled shoes.
- Do not apply lotions, powders or oil on the skin the day of the test, and refrain from wearing any perfume or cologne.
- Do not take your beta blocker medication for 24 hours prior to the test, unless instructed by the ordering physician to do so.
- On the day of the test, we often ask patients to delay taking their blood pressure and other heart medications. Your physician may give you specific instruction on this issue. If there is any uncertainty, do not take these medications and instead bring them with you to take as soon as the test is complete.
- If you are a diabetic you are able to have a piece of dry toast and clear juice the morning of your test.
What to Bring
- Current Medications List.
- Your insurance card. Without it, you will be asked to sign a waiver stating your responsibility for payment of the test.
- Insurance Referrals. If you are not sure your insurance requires a referral, please contact your primary care physician.
- Pre-Certification. Certain insurance plans require preauthorization for this test, including some PPO plans. Preauthorization needs to be obtained by the ordering physician’s office prior to the test.
- Prescription Order. A prescription order with the name of test and diagnosis is needed for the test to be performed.
Appointments canceled within 24 hours may result in a cancellation fee.
Failure to comply with any of the above will result in the rescheduling of your appointment.
Lexiscan (Chemical) Stress Test
A Lexiscan MPI stress test is a diagnostic heart test for patients unable to exercise on a treadmill. During the test, a small amount of a radioactive isotope is injected into a person’s bloodstream. The distribution of the radioactive isotope in the heart muscle is recorded by a camera after the heart is stressed with Lexiscan. The camera produces three-dimensional images of the heart that show the physician exactly where the heart muscle may not be receiving enough blood and oxygen. The total test lasts approximately three to four hours and is performed in multiple stages. In order to provide accurate results, adherence to the provided Patient Instructions is required.
At the start of your appointment, a technician will escort you to an exam room and start intravenous (IV) access. The IV line enables the technician to administer two different radioactive medications as required to perform your test, as well as the Lexiscan for stressing your heart. The technician will inject the first radioactive medication 15 minutes prior to placing you under the camera.
The camera is a partially enclosed device. You will lie on a table, and the ‘lens’ will rotate around you. It takes approximately 15 minutes for the camera to capture images of your heart.
Once we have taken a ‘resting image’ of your heart, the technician will escort you to the stress room. A clinician will attach an ECG monitoring cable, which enables us to monitor your heart rate and rhythm during the stress portion of your test. You will be given an injection of Lexiscan in your IV to stress your heart. Shortly after the injection, you may experience some chest, neck, head and /or abdominal discomfort. It is important that you notify the clinician of any symptoms. The presence of symptoms
does not imply a heart problem and may last approximately 5 minutes. The technician will inject a second radioactive medication into your IV immediately following the Lexiscan injection. Your blood pressure and ECG will be monitored by the clinician for at least five minutes following the injection or until any symptoms have resolved. The technician will then remove your IV and give you a glass of water to drink. You will wait in a private waiting area for approximately one (1) hour before re-imaging.
The technician will escort you to the camera room, where you will again lie on the table. As before, the camera requires 15 minutes to capture images of your heart. Once the imaging process is complete, you will be asked to get dressed while we process the images.
All results will be forwarded to the ordering physician in 24-48 hours.