Whom is Exercise Stress test for?

1. To diagnose coronary artery disease
2. To rule out angina as a cause of chest pains
3. To rule out suspected angina in patients with diabetes and exertional breathlessness ( no chest pains)
4. The doctor may use the Test, to guide treatment decisions in adjusting medications to assess for heart transplantation and advanced therapies in heart failure.
5. To help doctors in deciding about the need for angioplasty or CABG, in patients with previous damage heart damage due to heart attack.

Before Test

1. You will be provided specific information by the team whom requested test.
2. You may be asked not to eat, drink 3-4 hours before test
3. You have to avoid caffeine and caffeine containing products including coffee, tea, colas and other soft drinks, most chocolate products for at least 24 hours before the test. Caffeine will interfere with the results of the test
4. You may be asked to stop medications 48 hours before the test. (Confirm with your doctor). The medications include Beta Blockers, Nitroglycerin and Dipyridamole
5. Let your doctor know if you are using any other medications and over-the-counter medications before the test, because they might interfere with stress test.
6. If you are asthmatic, you must let your doctor know, as the medication (adenosine) use for test may interfere. The doctor may consider alternative test or medication for the test.

During Test

1. A Nuclear stress test is a non-invasive test. This test is performed, in a designated area due to involvement of nuclear medications.
2. The Doctor will inset an IV-Line (IV-Cannula) in your arm to radioactive dye (radiotracer a nuclear medication). An ECG/EKG monitor and Blood pressure would be attached.
3. The doctor will then inject the nuclear medication into your arm (you may feel cold or warm). You will be asked to wait for 20-40 minutes, so that the heart absorb the radiotracer.
4. The test has then 2 parts: Rest Part and Stress Part
5. Rest Part: This is performed by obtaining the The first set of your heart images via Camera.
6. Stress Part: This may be performed on same day or a different day. During this part, the heart is put under stress. This could be achieved by either of the following methods below ( depends on doctor’s recommendation).
1. Exercise test: Treadmill or bike ( click for details)
2. Medications that increases heart rate are injected via IV line OR medication that increase blood flow ( This is for patients who cannot exercise)
3. After stressing your heart (as above), you will have another injection of radiotracer. About 20 to 40 minutes later, the second sets of images of your heart muscle will be obtained.
4. Once you have the images taken, you will be able to go home, the doctor will compare both images (at rest) and (stress), and the results will be prepared.

How long does the procedure last?

This procedure may take upto 2-3 hours but may require more timings if any abnormalities noted

Possible Risks with Test

A nuclear stress exercise test is generally safe but some of the rare possible complications are:

1. Allergic reaction: It is rare but you could develop allergic reaction to the radioactive dye used for the test (Your doctor should be able to treat this immediately).
2. Drop in blood pressure: This may occur during or immediately after test, possibly causing you to feel dizzy or faint. This usually recovers quickly. This may be a normal response or related to underlying heart problem (ask your doctor).
3. Abnormal heart rhythms (arrhythmias):You may develop some extra beats or fast heart rates (Arrhythmias) during exercise test. You may feel dizzy or fait. This usually recovers quickly. This may be a normal response or related to underlying heart problem (ask your doctor).
4. Heart attack (myocardial infarction): Although extremely rare, but some patient may develop heart attack due to the underlying problem with the heart arteries.
5. Chest pains, Dizziness, or lightheadedness: These symptoms can occur during a stress test. They are usually mild and brief, but tell your doctor if they occur.

After a Stress Test

1. After you complete your exercise test OR if medications used, you will be may be asked to stand still for several seconds or sit down on chair for a short period for you to recover. Your ECG/EKG and blood pressure will be monitored for any abnormalities.
2. You may return to your normal activities unless your doctor tells you otherwise.
3. The nuclear medicine (radioactive material), will naturally removed by your urine and stool.
4. You are encouraged to drink more fluids.

Important Information

1. If you are pregnant or suspect that you might be, let your doctor or nurse know immediately. Nuclear Cardiology tests are not done, if you are pregnant.
2. Direct breast-feeding and close contact with young children should be avoided, for 4 hours after the test. For more information, Click here: Nuclear Radiolgy

Results

1. The test may be normal with Normal blood flow during exercise and rest. You may not need further tests.
2. Lack of radioactive dye in parts of your heart may indicate severe damage to heart due to previous heart attack.
3. Abnormal blood flow may be found by the test and the doctor may request for further additional tests, such as a coronary angiogram.

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