Nuclear stress test

Alternative Names

Sestamibi stress test; MIBI stress test; Myocardial perfusion scintigraphy; Dobutamine stress test; Persantine stress test; Thallium stress test; Stress test - nuclear; Adenosine stress test; Regadenoson stress test

Definition

Thallium stress test is a nuclear imaging method that shows how well blood flows into the heart muscle, both at rest and during activity.

How the Test is Performed

This test is done at a medical center or physician's office. It is done in parts, or stages:

You will have an IV (intravenous line) started.

Most people will then walk on a treadmill (or pedal on an exercise machine).

Your blood pressure and heart rhythm (ECG) will be watched (monitored) the whole time.

When your heart is working as hard as it can, a radiopharmaceutical is again injected into one of your veins.

Using a computer, your doctor can compare the first and second set of images. This can help your doctor tell if you have heart disease or if your heart disease is becoming worse.

How to Prepare for the Test

You should wear comfortable clothes and shoes with nonskid soles. You will probably be asked not to eat or drink anything after midnight, except for a few sips of water if you need to take medicines.

You will need to avoid caffeine for 24 hours before the test. This includes:

Your doctor will tell you if you need to stop taking any medicines before the test. Medications used to treat asthma and angina may interfere with test results. Never stop taking any medicine without first talking to your doctor.

It is important to tell your doctor if you have taken a dose of the following medications within the last 24 hours:

How the Test Will Feel

During the treadmill test, some people feel:

If you are given the vasodilator drug, you may feel a sting as the medication is injected, followed by a feeling of warmth. Some patients also have a headache, nausea, and a feeling that their heart is racing.

If you are given medication to make your heart beat stronger and faster (dobutamine), you may have a headache, nausea, or your heart may pound more strongly.

Rarely, during the test people experience:

If any of these symptoms occur during your test, let the lab personnel know immediately.

Why the Test is Performed

The test is done to see whether your heart muscle is getting enough blood flow, and therefore enough oxygen, when it is working hard (under stress).

Your doctor may order this test to determine:

The results of a nuclear stress test can help your doctor:

Normal Results

A normal result means blood flow through the coronary arteries is probably normal.

The meaning of your test results depends on the reason for the test, your age, and your history of heart and other medical problems.

What Abnormal Results Mean

Abnormal results may be due to:

After the test you may need:

Risks

Complications are rare but may include:

Your health care provider will explain the risks before the test.

Considerations

Non-heart structures, such as the diaphragm and breast tissue, can sometimes cause false positive test results when older  methods are used to show how well blood flows into your heart muscle. Special techniques can prevent this problem and reduce the need for further testing.

Further tests may include a cardiac catheterization.

References

Cramer CM, Beller GA. Noninvasive cardiac imaging. In:Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 56.

Fraker TD Jr, Fihn SD, Gibbons RJ, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the managementof patients with chronic stable angina. Circulation. 2007;116:2762-2772.

Mahajan N, Polavaram L, Vankayala H, et al. Diagnostic accuracy of myocardial perfusion imaging and stress echocardiography for the diagnosis of left main and triple vessel coronary artery disease: a comparative meta-analysis. Heart. 2010;96(12):956-966.

Fraker TD Jr, Fihn SD, Gibbons RJ, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007;116:2762-2772.