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Exercise Stress Test with Myocardial Perfusion Imaging
Other Names: Nuclear Stress Test; Isotope Stress Test; Thallium; Myoview
Why is this test ordered?
It is ordered for patients with symptoms or signs that are suggestive of coronary artery disease, or patients with significant risk factors for coronary artery disease. It can also be used to evaluate exercise tolerance when patients have unexplained fatigue and shortness of breath, to evaluate blood pressure response to exercise in patients with borderline hypertension or to look for exercise-induced serious irregular heart beats.
What does it do?
It is designed to screen for the presence of coronary artery disease. Coronary artery disease is caused by inadequate blood supply to the heart, usually due to blocked arteries. In general terms, the tests looks for blockages in the arteries of the heart.
What is the procedure like?
An IV will be placed in a vein in your arm for the administration of the radioactive tracer. The IV will be removed before you leave. The test involves an injection of a small amount of a clear radioactive liquid called Myoview which circulates in the bloodstream and shows if your heart muscle is receiving adequate blood supply under stress and rest conditions.
Pictures of your heart will be taken by a nuclear camera while at rest and after exercising. You lie down with you arm over your head for about 15 minutes each time you are on the camera.
You will be asked to walk on a treadmill in order to increase your heart rate and place physical stress on your heart. The pace on the treadmill starts out very slowly and increases mildly every 3 minutes. The treadmill also slopes up gradually every 3 minutes. Most people walk between 6-12 minutes on the treadmill. Most people do not have to run on the treadmill, only walk.
What if I need to cancel?
The radioactive material is ordered especially for you. If you are unable to keep your appointment for any reason, please call 24 hours in advance. If you do not notify us 24 hours in advance, we may have to bill you for the radioactive material.
What preparation do I need?
Pregnancy: If you are pregnant DO NOT TAKE THE TEST. If you are pregnant or suspect you may be, notify your doctor before taking the test.
Breastfeeding: You cannot breastfeed for 24 hours after receiving the radioactive agent. You will have to pump breast milk and discard it for those 24 hours.
Fasting: You need to eat nothing for at least 4 hours before the test. Do not have coffee for at least 8 hours before the test. You may drink water at any time before the test. You may take your medicines before the test unless advised otherwise by your doctor. Please contact your doctor's office for more information.
Medications: Do NOT take the following medications for 24 hours before the test:
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What can the test show?
If the test is normal during both exercise and rest, then blood flow through the coronary arteries is normal. The coronary arteries supply blood to the heart muscle.
If the test shows that perfusion (blood flow) is normal during rest but not during exercise (a perfusion defect), then the heart isn't getting enough blood when it must work harder than normal. This may be due to a blockage in one or more coronary arteries.
If the test is abnormal during both exercise and rest, there's limited blood flow to that part of the heart at all times. This part of the heart may be dead from a prior heart attack. It has become scar tissue.
What is the reliability of the test?
If a patient is able to achieve the target heart rate and if good quality images are obtained, an isotope treadmill stress test is capable of diagnosing important disease in approximately 80% of patients with coronary artery disease. Approximately 10% of patients may have a "false-positive" test (when the result is falsely abnormal in a patient without coronary artery disease).
When will I know the results?
If the test is markedly abnormal, the physician will speak with before you leave; otherwise, you will have a follow-up appointment within two weeks to discuss the results.