nuclear stress instructions and consent form - Heart & Vein Center

NUCLEAR STRESS TEST
What is a nuclear stress test?
During a stress test, an electrocardiogram (EKG) is done while you are at rest and under exertion. A nuclear stress test
includes an additional component, which produces images of your heart. These images reveal scarring or any reduction
in blood flow that occurs before, during or after physical exertion. These tests are extremely helpful in determining:
• Causes of chest pain (due to blockages in the coronary arteries).
• Prognosis of patients who have had a myocardial infarction (heart attack).
• Effectiveness of a cardiac procedure performed (i.e. stents, balloon angioplasty, bypass, etc.).
• Maximum level of exercise that a patient can safely perform.
How does the nuclear stress test work?
Through a technique known as “single photon emission tomography” (SPECT), a special camera detects the rays
emitted from a radioactive substance, called Cardiolite®, that is injected into the blood stream. The rays produce images
of your heart on a video monitor. Cardiolite® is absorbed by healthy tissue rather than diseased/damaged tissue. The
difference becomes evident on the images produced by the nuclear camera. These images provide the physician with
specific information about oxygenated blood flow through your coronary arteries to the heart muscle, and the ability of
your heart to keep up with the increased oxygen demands during physical exertion.
What happens after the nuclear stress test?
After the test, the patient can eat, drink and resume normal life. The physician will determine the results within 24 hours
of the test. Based on the results, a treatment plan will be devised for the patient (i.e. heart catheterization or medical
therapy).
Do not…
NUCLEAR STRESS TEST PREPARATIONS
• Do not eat a heavy meal at least 4 hours prior to test
*A small meal 2 hours prior is okay (i.e. toast/oatmeal/cereal with juice/milk)
• Do not consume caffeine 24 hours prior to test
*Avoid regular AND decaffeinated coffee, tea, soda, and chocolate
• Do not use tobacco at least 24 hours prior to test
• Do not consume alcohol at least 12 hours prior to test
• DO NOT TAKE AGGRENOX ® 24 HOURS PRIOR TO TEST
• Do not use skin moisturizer on the day of your test
*EKG electrodes do not stick to moisturized skin; it is okay to use deodorant
• Do not use any inhalers containing “Theophilline” 24 hours prior to your test
• DO NOT TAKE BETA OR CALCIUM CHANNEL BLOCKERS 12 HOURS PRIOR TO
TEST
*Stop these medications the day before your test (it is safe to do so)
*Resume taking the usual dose after the test (you do NOT need to double the dose!)
Common BETA BLOCKERS: Acebutolol, Atenolol, Betapace, Coreg, Corgard, Corzide,
Inderal, Inderide, Innopran, Levatol, Lopressor, Metoprolol, Nadolol, Normodyne, Pindolol,
Propanolol, Sectral, Sotalol, Tenoretic, Tenormin, Timolol, Timolide, Toprol, Trandate,
Zebeta
Common CALCIUM CHANNEL BLOCKERS: Calan, Cardene, Cardizem, Cartia, Covera,
Dilacor, Diltiazem, Dynacirc, Isoptin, Tarka, Tiazac, Verapamil, Verelan
Do…
• Take all your medications OTHER THAN BETA/CALCIUM CHANNEL BLOCKERS &
AGGRENOX
• Wear comfortable clothing, walking shoes, and loose sleeves!
• Bring a sweater! The nuclear lab is chilly!
• Arrive at the scheduled time for your test! Your Cardiolite® doses are time sensitive!
• Bring a snack to enjoy after the ”stress” portion of your test!
30301 Woodward Avenue Suite - LL160
Royal Oak, MI 48073
Ph: (248) 655-4490 Fax: (248) 655-4491
www.HeartandVeinCenter.com

EXERCISE STRESS TEST:
Patient:
• Takes 3 hours (assuming there are no unforeseen delays)
• Temporary IV is started, enabling the 1 st dose of Cardiolite® to be injected
• Once injected, you will wait for the Cardiolite® to reach your heart (30 minutes)
• Next, images of your heart (at rest) will be taken by the nuclear camera (15 minutes)
• After the 1 st nuclear scan, you will exercise on a treadmill while monitored by an EKG
• When you’ve reached your target heart rate, a 2 nd dose of Cardiolite® is injected
• Once the 2 nd dose of Cardiolite® has been injected, you will exercise for 1 additional
minute and then wait for the Cardiolite® to reach your heart (25 minutes)
• Lastly, a 2 nd scan of your heart (after stress) will be done by the nuclear camera (15 minutes)
PHARMACOLOGICAL STRESS TEST:
• Takes 3 hours (assuming there are no unforeseen delays)
• Temporary IV is started, enabling the 1 st dose of Cardiolite® to be injected
• Once injected, you will wait for the Cardiolite® to reach your heart (30 minutes)
• Next, images of your heart (at rest) will be taken by the nuclear camera (15 minutes)
• After the 1 st scan, you will undergo a Lexiscan® infusion while monitored by an EKG
• Immediately after the infusion, a 2 nd dose of Cardiolite® is injected
• After 2 nd dose of Cardiolite® is injected, it will be given time to circulate in your system (25 minutes)
• Lastly, a 2 nd scan of your heart (after stress) will be done by the nuclear camera (15 minutes)
PATIENT CONSENT
(Please read and sign)
There exists the possibility of certain events occurring during any form of stress testing. These events
include abnormal blood pressure, fainting, abnormal heart rate (too fast, too slow, or ineffective) and rare
instances of heart attack. A preliminary examination and close observations during the test allow us to
minimize these risks as much as possible. Emergency equipment and trained personnel are present at all
times during your test, to deal with these situations, should they arise.
The information that is obtained from your stress test results is privileged and confidential and will not be
released or revealed to any person (except your treating physicians) without your written consent. The
information obtained may be used, however, without your actual identification being revealed, for a statistical
or scientific purpose.
Date of Appointment: Time:
I have read and understand the previous explanations of the test preparations, risks, and
confidentiality pertaining to my scheduled stress test.
-AND-
I am aware that there is a $250.00 charge if I fail to cancel or reschedule my appointment at least 48
hours prior to my scheduled appointment.
Patient Signature Date