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Nuclear Stress Test


Long Island Heart Associates performs nuclear stress tests, also known as thallium stress test, in order to look for blockages in the coronary arteries. A Nuclear camera takes images of the heart and projects them onto a computer screen. These images show blood flow to the heart muscle which indicates strength or weakness of the heart.

 

What to expect during the nuclear stress test:

During the Nuclear stress test, images of the heart are taken both during exercise and rest.  To exercise the heart, patients usually walk on a treadmill.  If exercise is not feasible or recommended, a small dose of medication is given to increase the heart rate or blood flow to the heart. The first pictures of the heart are taken after the patient receives a small dosage of Thallium® or Technitum®.  Thallium® is an isotope that clings to the heart muscle and allows the nuclear camera to see images of the heart. Thallium® is extremely safe and there are no known adverse or allergic reactions.

 

The patient lies on a table under the camera for approximately 15 minutes while the camera circles around them and records information. Next, the patient is exercised on the treadmill or given a dose of medication to increase the blood flow.  A LIHA doctor monitors the patient’s blood pressure during the exercise and makes sure that the patient reaches his/her maximum level of exercise. After exercise levels have been reached, the patient receives another small injection of Technitum®, another radio isotope, and again lies down under the camera. Images of the heart after exercise are then taken.

 

What does a nuclear stress test show?

  • If blood flow to the heart is not blocked after exercise and rest, then the coronary arteries do not have a significant stenosis.
  • If the test shows that blood flow is normal during rest, but abnormal during exercise, then the heart is not receiving enough blood when it is working harder than normal.  This may be due to a blockage in one or more of the coronary arteries.
  • If the test is abnormal during both exercise and rest, there is limited blood flow to the patient’s heart at all times.  This could suggest a prior heart attack.
  • Your cardiologist will review the results of your thallium stress test with you as soon as the test is complete and the pictures are developed.  They will advise you of treatment options if your test is abnormal.

 

How to prepare for a nuclear stress test

  • It may be a good idea to bring something to read or occupy your time in between the various portions of the test.  You may be at the office for as long as 4 hours.
  • Please arrive at least 15 minutes early to fill out  paper work if you are a new patient or if your insurance information has changed.
  • No caffeine or de-caffeinated drinks for 24 hours prior to your test time– drink water, juice, or milk.
  • No solid foods for 4 hours before your test. If you are scheduled for an afternoon test, try to have breakfast at least 4 hours prior to your test.

For 24 hours before the test, do not take the following medications:

  • Beta Blockers such as: Toprol XL®, Metoprolol®,   Lopressor®, Coreg®, Atenolol®, Tenormin®, Bystolic®, Carvedilol ®.
  • Calcium Blockers such as: Tiazac®, Cardizem CD®, Diltiazem®, CD®, Cartia Verapamil®, Calan®, Cardizem LA®.
  • Nitrates such as: Imdur®, Isosorbide®, Nitropatch®.
  • No Excedrin®.

*Note: Consult your doctor as some other medications may not be listed

  • If you are taking other medications for your heart or if you are a diabetic, please check with your doctor before taking medications on the day of the test.
  • You may bring a light snack to have after the stress portion of the test.
  • Wear loose comfortable clothing and sneakers with rubber soles.  No flip flops or open toe shoes. Do not wear shirts or blouses with metal buttons or zippers.
  • Please notify our office if you are severely claustrophobic.
  • Since there are no adverse side effects from the thallium stress test, you will be able to drive immediately following.

 

Stress Echocardiogram


A Stress Echocardiogram at LIHA is a non-invasive test that combines 2 tests – a treadmill stress test and an echocardiogram. The echocardiogram is an ultrasound of the heart which enables us to visualize the heart valves, blood flow through the valves, and size and structure of the heart. If there are any abnormalities in heart function after exercise, this may be due to a blocked artery or CAD. This information is useful to your doctor to help establish a diagnosis and guide your treatment.

 

What do I have to do to prepare for a stress echocardiogram?

  • Nothing to eat for 4 hours prior, with the exception of water.
  • Ask your doctor about adjusting insulin and food intake if you are a diabetic.
  • Do not apply lotions or oils to your body.
  • Wear loose comfortable clothing and sneakers with rubber soles. No flip flops, sandals or open toe shoes.

 

What can I expect before, during, and after a stress echocardiogram?

A stress echocardiogram is performed by a cardiologist who will be assisted by a technician called an echocardiographer. Echocardiographers have received special training and certification in operating echo equipment and ensure that the most detailed pictures of your heart are obtained. The heart doctor and the echocardiographer will explain the test and answer any questions you may have.

 

The echocardiographer will place electrodes on your chest to monitor your heart rate and rhythm throughout the test. First the echo will be done at rest while you lie on the exam table. Immediately following, you will begin to walk on the treadmill. The treadmill normally gets faster and steeper approximately every 3 minutes. You will be exercising until the doctor says you have done enough or you indicate that you have done enough. If you experience any chest pain, shortness of breath or you become too tired, tell the doctor and the treadmill exercise will be stopped. When the treadmill is stopped, you will then lie down on the exam table and the second echo will be immediately performed. This is done to visualize heart functioning after exercise.

 

The test usually takes anywhere from 45 minutes to 1 hour. If you are unable to walk on the treadmill, your doctor may order a stress echo with a special medicine called Dobutamine®. Dobutamine® is a medicine that gradually increases your heart rate, which eliminates the need for exercise. In some patients, when a good quality echo cannot be obtained, the doctor may administer an intravenous medication to improve your pictures. The doctor will discuss this will you if it is necessary. Test results are given that day.

 

Medication instructions for a stress echo:

To make your stress echo is as accurate as possible; we ask that you do not take the following medications the evening prior or the day your test is scheduled:

  • Do NOT take any beta-blockers. These include but may not be limited to: Toprol-XL®, Lopressor (Metoprolol)®, Tenormin®, Inderal®, Bystolic®, Corgard®, Coreg®(or Carvedilol®)
  • Do NOT take any calcium channel blockers that slow the heart rate. These include but may not be limited to: Cardizem CD®, Cardizem LA®, Calan®, Calan SR®, Verelan (Verapamil®), Tiazac®

For patients with certain arrhythmias, poorly controlled hypertension or severely blocked arteries, holding your medications may not be advisable. Please check with your cardiologist before your stress echo.

 

Chemical Stress Test


At Long Island Heart Associates, we take every patient’s needs into consideration. If a patient is unable to walk on the treadmill for their nuclear stress test, then our doctors will perform a chemical stress test. Each patient that needs a chemical stress test will be given one of the three drugs; Lexiscan®, Adenoscan®, Dobutamine® in order to get your stress levels up. This will help look for any blockages in the coronary arteries. Conveniently, a chemical stress test provides the patient with the same results, preparation, and instructions as a nuclear stress test.

 

How to prepare for a chemical stress test:

  • It may be a good idea to bring something to read or occupy your time in between the various portions of the test.  You may be at the office for as long as 4 hours.
  • Please arrive at least 15 minutes early to fill out paper work if you are a new patient or if your insurance information has changed.
  • No caffeine or de-caffeinated drinks for 24 hours prior to your test time– drink water, juice, or milk.
  • No solid foods for 4 hours before your test. If you are scheduled for an afternoon test, try to have breakfast at least 4hours prior to your test.

For 24 hours before the test, do not take the following medications:

  • Beta Blockers such as: Toprol XL®, Metoprolol®,   Lopressor®, Coreg®, Atenolol®, Tenormin®, Bystolic®, Carvedilol ®
  • Calcium Blockers such as: Tiazac®, Cardizem CD®, Diltiazem®, CD®, Cartia Verapamil®, Calan®, Cardizem LA®
  • Nitrates such as: Imdur®, Isosorbide®, Nitropatch®
  • Excedrin                    



*Note: Consult your doctor as some other medications may not be listed

  • If you are taking other medications for your heart or if you are a diabetic, please check with your doctor before taking medications on the day of the test.
  • You may bring a light snack to have after the stress portion of the test.
  • Wear loose comfortable clothing and sneakers with rubber soles.  No flip flops or open toe shoes. Do not wear shirts or blouses with metal buttons or zippers.
  • Please notify our office if you are severely claustrophobic.
  • Since there are no adverse side effects from the chemical stress test, you will be able to drive immediately following.

 


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