The Myocardial Perfusion Imaging stress test is done in our nuclear medicine department. The test is performed on outpatients in our office. A small amount of radioactive material is injected and circulates in the bloodstream, showing whether or not the heart muscle is receiving an adequate blood supply under stress and/or rest conditions.

The radioactive injection is a clear liquid called Thallium, is used under resting conditions. Another material, Myoview, is used under stress conditions and/or resting conditions.

Any stress procedure may have some risks. You should consult with your physician regarding the risks and benefits of this procedure. The radioactive materials, Myoview and Thallium, have been shown to be safe, with low incidence of adverse reaction. Myoview and Thallium are not “dyes,” and there should be no serious side effects from their injection.

Under certain circumstances, a regular stress test may yield indeterminate results. To improve the diagnostic accuracy, your physician may request a myocardial perfusion stress test.

The test usually consists of two parts--under resting conditions and after exercising. There are many variations for performing the test but, usually it is done in one day in our office. There are certain circumstances that may warrant a two day test. You will be informed of this ahead of time. If your test is completed in one day, you will be injected with Thallium under resting conditions; then Myoview will be administered by injection during peak exercise. If your test is completed in two separate days, Myoview will be administered by injection during peak exercise, and once again the following day, while you are at rest. ECG electrodes will be attached to your chest. This will allow the physician to monitor your heart rate before, during, and after you have exercised. A blood pressure cuff will be placed on your arm to monitor your blood pressure before, during, and after exercise. Additionally, an intravenous (IV) line will be placed in your hand or arm vein to allow for ease of the Myoview and/or Thallium injections. The IV will be removed when the exam is completed. The exercise part of the exam is usually done on a treadmill. Exercising will begin slowly, and every three minutes the pace will gradually increase. As you exercise, your heart rate and blood pressure will change. This is normal. Remember that you are being closely monitored throughout the exam. At your peak exercise, Myoview will be injected into the IV, and you will be asked to continue exercising for an additional 1 or 2 minutes. Approximately 15 to 30 minutes after the exercise is complete, pictures will be taken of your heart using a special camera that is able to trace either Myoview or Thallium that has localized in your heart. You will be asked to lie down on a special table. The camera will rotate above and around your chest while special pictures are being taken. This will take approximately 20 to 30 minutes to complete.

It is very important that you breathe normally and hold very still while the camera takes pictures of your heart. You will not receive any radiation from the camera. The resting pictures are taken in the same manner as the exercise pictures. The total time needed for the test also varies, and may take 2 to 3 hours.

Some people, due to a variety of disabilities, are unable to exercise adequately enough on a treadmill machine to achieve a diagnostic test result. In these cases, your physician may decide to use a drug to mimic the effect of exercise on the heart (pharmacological stress). Drugs that mimic exercise on a treadmill are commonly used for this purpose. If you notice any changes in the way you feel, or experience any side effects, notify the individual who is closely monitoring the test.

CLOTHING
Wear loose-fitting clothing and comfortable walking shoes. This facilitates walking on the treadmill.

FOOD
Your physician may instruct you to have nothing to eat 4 hours prior to the exam. Avoid caffeine-containing beverages 24 hours prior to the test. If you are diabetic or insulin-dependent, consult with him/her on such dietary restrictions and insulin use.

MEDICATIONS
Consult with your physician regarding whether certain medications should be taken before, or held until after the test. Certain medications may interfere with the effectiveness of the exam.

• There may be two parts of the exam. You may have to return for the second part.
• You may receive an injection for both parts of the exam.
• The radioactive material is ordered especially for you. If you are unable to keep your appointment for any reason, notify the department before the exam.
• A written report of the test will be sent to your physician once it is interpreted.
• If you are pregnant or suspect you may be, notify your doctor before taking the test.

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