Nuclear Cardiac Stress Test is a diagnostic procedure used to evaluate the distribution of blood flow to your heart. It usually involves a treadmill EKG stress test and Nuclear Medicine imaging. The test is usually done in a hospital radiology or nuclear medicine department, a doctor's office, or at an outpatient clinic. The test is done by a doctor and technologist trained in nuclear heart medicine.

A stress scan is done to:

* Diagnose coronary artery disease, a condition that results in ischemia (blockage or impairment of blood flow to heart muscle).
* Check the effectiveness after bypass surgery, angioplasty or thrombolysis (clot dissolving) of the coronary arteries.
* Evaluate the effectiveness of cardiac medications.
* Evaluate your heart prior to surgery.
* Determine the amount of permanent damage caused by a heart attack and evaluate the remaining healthy (viable) muscle.
* Help determine the best form of treatment for you when needed, such as medication, surgery or bypass surgery.

Test Preparation

Preparation for the test will depend on several factors, including age, fitness level and pre-existing medical problems. You may be asked to:

* Not eat anything three to four hours before the test is performed because images of your heart will be easier to interpret if your stomach is empty. Also, some people may get an upset stomach if they exercise too soon after eating.
* You must check with your doctor to find out whether you should stop taking your medications, particularly heart medicine, because they may interfere with the accuracy of the test results.
* Wear shorts or slacks for the exercise portion of the test, although the technologist will provide you with a hospital gown for the imaging session. Be sure to wear comfortable shoes, such as sneakers or running shoes, because you may have to do your exercising on a treadmill or stationary bicycle.

Exam Procedure

An intravenous tube is placed in your arm for injection of a small amount of radioactive tracer administration. Once the radioactive tracer has been injected into the bloodstream, a special camera is used to obtain images of the tracer enters heart muscle. For the exercise test, small pads called electrodes are placed on your chest so that an electrocardiogram (EKG) can monitor your heart rhythm while you exercise. The exercise will typically consist of walking on a treadmill or using an exercise bike. As the exercise continues, it becomes more difficult (similar to walking up a hill). As the exercise progresses, the heart rate and blood pressure rise. You will be asked to exercise as long as you can.
You will receive a second injection of radioactive tracer about one minute before the end of the exercise session. Another set of images will be taken. The radioactive tracer will remain in your body for less than a day and will have no ill effects.
If a previous medical problem or physical condition prevents you from exercising, your doctor may request that using a special medication (Persantine, Dobutamine or Adenosine) instead of exercise induce the stress symptoms. For Persantine studies, Caffeine and medication containing or Theophylline must be avoided 48 hours prior to the test. Other imaging protocols exist, but the Rest/ Stress method above is one of the more popular.

Results
A defect in blood flow that is seen following exercise, but not seen at rest, suggests the ischemia (inadequate blood flow to the heart muscle).
A defect in blood flow that is present during rest and exercise may indicate a past heart attack or very severe ischemia. Your doctor will obtain the results and decide what medication or treatment is needed for your care.

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