Patient
Information

Your Nuclear Medicine Stress Exam . . .

What Is It

Precautionary Information

What Should I do Before The Test

Cardiolite^® Treadmill Test

Cardiolite^® Adenosine Test

Cardiolite^® Dobutamine Test

What Happens after my Treadmill, Adenosine,
or Dobutamine Stress Test??

WHAT IS IT?

The heart receives life-giving blood from vessels called coronary arteries. If these arteries become partially blocked or narrowed by the accumulation of fatty materials, the heart may not receive the blood it needs to f:unction properly. This narrowing of coronary arteries is called coronary atherosclerosis or, more commonly, coronary artery disease (CAD).

As CAD progresses, the heart muscle may not receive enough blood when under stress (for example, when exercising). This often results in chest pain called angina pectoris. On the other hand, there may be no outward physical signs of the disease. If CAD is limiting blood flow to a part of your heart, the nuclear stress exam may be useful in detecting the presence and significance of CAD.

There are three types of procedures that can be used for this test. Your Cardiologist will determine which one you should take

PRECAUTIONARY INFORMATION

CARDIOLITE^® TREADMILL TEST
The CARDIOLITE^® administered during this stress exam contains a small amount of radioactivity. The amount of radiation you will be exposed to is comparable to that from an x-ray CAT (CT) scan.
Adverse patient reaction to CARDIOLITE^® is rare. You may briefly notice a metallic taste a few seconds after injection has occurred. Other side effects have rarely occurred.

I.V. ADENOSINE
I.V. Adenosine may cause some side effects. In most cases, these effects may subside quickly or be easily reversed. Some of these effects may be experienced during or immediately after the test, including chest pain, headache, dizziness, changes in heart rate and blood pressure, nausea and flushing

I.V. Dobutamine
I.V. Dobutamine is used for asthma patients. Side effects which may occur include chest pain, headache, dizziness, changes in heart rate and blood pressure, nausea and flushing, heart pounding and jittemess.

WHAT SHOULD I DO BEFORE THE TEST?

• You will be asked not to eat or drink 4 to 6 hours prior to the test. This will minimize the possibility of nausea, which may accompany vigorous exercise after eating. In addition, the pictures of your heart are more clear when the stomach is not full.

• Your cardiologist may decide to temporarily discontinue certain heart medications prior to the stress exam. These are discontinued because some heart medications may interfere with the accuracy and effectiveness of the exam.

• A hospital gown maybe provided on the day of the test. Slacks or shorts are preferred for the exercise portion of the exam. You should wear comfortable footwear appropriate for brisk exercise on a treadmill (a moving belt you walk on) or stationary bicycle. You will work hard during the test and comfortable clothing will make it easier for you.

I.V. ADENOSINE - Additional Instruction

If you are having an I.V. Adenosine Stress Test, it is imperative that you do not eat anything for the 6 hours preceding your test. It is also important to avoid the following foods and medications prior to your test. Many of these contain caffeine or Theophylline which may interfere with the accuracy of the test.  

Commonly Used Beverages and Foods Containing Caffeine

Some of the medicines containing Theophylline that should be avoided
36-48 hours be ore your test.
Prescription Medications Containing Theophylline*

I.V. DOBUTAMINE - Additional Instruction

If you have an I.V. Dobutamine Stress Test, take breathing medications as usual. Bring your inhalers with you. Do not take your heart medication the day of the test. Other medications maybe taken as prescribed. Please do not eat 4 - 6 hours prior to the test.

CARDIOLITE^® TREADMILL PROCEDURE

What will happen to me?

Prior to the stress exam, you will be asked to sign a consent form. Please read the form carefully. If you have any questions about the procedure, do not hesitate to ask the person supervising the test. He or she can explain the entire procedure before it begins.

An intravenous line (IV) will be placed into your arm. This line will be used to inject CARDIOLITE^® into your blood- stream for the first part of your test. This line will also be used throughout the test and will be removed as soon as the procedure is completed.

The technologist will begin taking pictures 30 minutes after your injection. This is called imaging. For this portion of the exam, you will be asked to lie flat on an imaging table. Imaging begins with the camera positioned close to your chest.

Two procedures can be used to image your heart: Planar Imaging and Single Photon Emission Computed Tomography (SPECT).

A Planar Imaging procedure typically consists of single images taken at three different angles. Each image takes about five to ten minutes to produce.

During a SPECT procedure, the camera moves slowly around your chest in an arc- like fashion. Each image takes approximately 20 to 30 seconds. The entire SPECT procedure typically lasts 12-15 minutes.

During both of the procedures it is important to stay as still as possible while the pictures are being taken.

After the first set of pictures is completed you will be moved to the exercise room. We use this room to prepare you for either the treadmill or the adenosine procedure. Several small pads called electrodes will be placed on your chest. The pads will be connected to an EKG monitor so the cardiologist can monitor your heart rhythm closely during this portion of the test.

Several electrodes will be placed on your chest, and an IV will be placed in your arm.

You will exercise by walking on a moving belt, called a treadmill, or you will be given a drug called Adenosine to stress your heart. Please follow the instructions for the test checked on the front of this pamphlet.

If you walk on the treadmill, it will move very slowly at first, then in- crease in speed. As you exercise longer and harder, your heart rate and blood pressure will rise. This is nor- mal and they will be monitored along with your EKG.

You will be encouraged to continually exercise throughout the stress exam. If you experience any unusual symptoms at any time, such as light- headedness, immediately tell the individual monitoring the test. Adjustments will be made to the exercise test, depending on your symptoms, blood pressure, EKG, or degree of fatigue. To increase the effectiveness of the test, it is important to exercise as long as you are able.

CARDIOLITE^® will be injected into the IV line approximately one minute before the end of exercise. The isotope will be carried to the heart via the bloodstream.

The technologist will begin taking pictures following your exercise. These will be taken the same way as the ones taken earlier.

I.V. ADENOSINE STRESS TEST PROCEDURE

The Adenosine Stress Test differs from the treadmill test in that you will be given I.V. Adenosine to stress your heart - you will not be exercising on the treadmill

First, the doctor will give you I.V. Adenosine through the I.V. line. This usually takes about 6 minutes. If you have any unusual sensations during or immediately following the test, it is important to let the doctor know so that he/she can deal with them.

A few minutes after you receive I.V. Adenosine, the doctor will give you Cardiolite, also through the I.V. line. A special camera that can detect the isotope carried to your heart through the coronary arteries will be placed close to your chest and pictures will be taken. This is called imaging.

How does the I.V.ADENOSINE-CARDIOLITE^® test work?

During the first part of the test, Adenosine is given to expand (dilate) the coronary arteries, similar to what would happen during vigorous exercise. Arteries that have become narrowed because of coronary artery disease will not be able to expand as much as normal arteries. CARDIOLITE^® is given a few minutes after I.V. Adenosine. These isotopes travel freely through the normal arteries that have been expanded by I.V. Adenosine and less so through these arteries that are narrowed. CARDIOLITE^® contains a very small amount of radioactivity that can be detected by a special camera the doctor uses to take pictures of your heart. By studying these pictures the doctor will be able to see which areas of the heart may not be receiving a sufficient blood and oxygen supply.

I.V. DOBUTAMINE STRESS TEST PROCEDURE

Dobutamine will be administered I.V. in the presence of a doctor. It will continue until 85% or more of your maximum heart rate is achieved or until the doctor determines otherwise. At that time CARDIOLITE^® will be injected to capture

the coronary arteries delivering as much blood as possible to the heart muscle and to determine if those arteries have narrowed when asked to perform. CARDIOLITE^® contains a very small amount of radioactivity that can be detected by a special camera the doctor uses to take pictures of your heart. By studying these pictures, the doctor will be able to see which areas of the heart may not be receiving a sufficient blood and oxygen supply.

Please remember to follow the instructions mentioned earlier in this brochure to prepare for your test.
Be sure to tell the doctor administering the test:
a) If have any allergy to theophylline or dipyridamole, or
b) If you have asthma, chronic lung disease or any heart conditions, or
c) If you have consumed any of the beverages or foods listed on page 4
d) within 12 hours before your test, or d If you have taken any of the
medicines listed within 3 days before your test.

What Happens After My Treadmill, Adenosine,
or Dobutamine Stress Test??

Following completion of the exam, the doctor will discuss the results of the test with your own physician and submit a written report. Your physician will then explain the test results and their implications to you.
• If follow-up testing is needed, this office will arrange all necessary appointments for you.
• If you have any further questions please feel free to contact us.