Stress Tests

Exercise Treadmill

An exercise treadmill is a noninvasive test used to diagnose coronary artery disease. Your doctor has ordered this because you are having symptoms of chest pain or because you have significant risk factors for coronary disease. A treadmill is also frequently ordered prior to embarking on an exercise and weight loss program.

If you are taking a beta blocker medication, this must not be taken on the day of the treadmill, as it will prevent your heart rate from achieving its peak value, a very important part of the test. During this test, a clinical technician will hook you up to EKG leads and you will be asked to walk on a treadmill. The treadmill will start off slowly and will become progressively faster and steeper. The longer you are able to walk on a treadmill, the more information will be obtained about your heart. During the treadmill, your doctor will monitor your EKG and will also assess you for symptoms.

Exercise Echocardiogram

An exercise echocardiogram is a noninvasive test used to diagnose coronary artery disease. Your doctor has ordered this because you are having symptoms of chest pain or because you have significant risk factors for coronary disease. If you are taking a beta blocker medication, this must not be taken on the day of the treadmill, as it will prevent your heart rate from achieving its peak value, a very important part of the test. During this test, you will lie on a table on your left side and a resting echocardiogram of your heart will be performed. You will then be hooked up to EKG leads and you will be asked to walk on a treadmill. The treadmill will start off slowly and will become progressively faster and steeper. The longer you are able to walk on a treadmill, the more information will be obtained about your heart.

During the treadmill, your doctor will monitor your EKG and will also assess you for symptoms. When you have achieved your peak heart rate and level of stress, the treadmill will be stopped and you will quickly lie down again on your left side and repeat images of your heart will be obtained. Your doctor will then compare the images obtained after exercise to those obtained at rest and can assess if your heart is able to function normally under the measured work load of the treadmill.

Dobutamine Stress Echo

A dobutamine stress echo is a noninvasive test used to diagnose coronary artery disease. Your doctor has ordered this because you are having symptoms of chest pain or because you have significant risk factors for coronary disease. If you are taking a beta blocker medication, this must not be taken on the day of the treadmill, as it will prevent your heart rate from achieving its peak value, a very important part of the test. During this test, you will lie on a table on your left side and a resting echocardiogram of your heart will be performed. You will then be hooked up to EKG leads and an IV will be placed in your arm. You will then be given dobutamine, a medication that will cause your heart to beat rapidly and vigorously.

This is a way of simulating exercise and making the heart work without actually walking on a treadmill. This way of placing a work load on the heart is ideal for patients who cannot exercise well on a treadmill. During the infusion, your doctor will monitor your EKG and will also assess you for symptoms. When you have achieved your peak heart rate and level of stress, the drug infusion will be stopped and peakl images of your heart will be obtained. Your doctor will then compare the images obtained after dobutamine to those obtained at rest and can assess if your heart is able to function normally under the measured work load of dobutamine.

Two-Day Adenosine Cardiolite Stress Test

Part two will be on another day. You will meet your nurse and she will explain the next part of the test and answer any questions you have. It is important that you follow your pre-test instructions. These instructions must be followed as certain drugs you might be taking (theophylline, beta-blockers and caffeine) have an adverse affect on the test results. Taking them will require the test to be rescheduled. Your blood pressure will be monitored and you will be connected to an electrocardiogram (EKG) machine that will constantly display your heart rhythm and rate. During this part of the test, you will be given a medication called adenosine via the IV in your arm. The medication is given to expand (dilate) the heart's arteries. Healthy or normal arteries dilate more than partially blocked arteries thus allowing more isotope to accumulate in the heart. During this test, you may be asked to walk slowly on the treadmill to help dissipate any side effects. Some patients experience mild side effects with the medication such as:

Feeling a little "light-headed"
Feeling flushed in the face and chest
Feeling pressure in your throat or chest

When the medication has taken effect, after 2 minutes, a small amount of isotope is again injected and the medication is continued for 2 more minutes. Once the medication has been stopped, the side effects will disappear within 1 minute. It is important to remember that if you have side effects this does not mean you have heart disease.

After the medication has been stopped, there is a short recovery period and then an approximate 20-30 minute break at which time you will relax and have the snack you brought. It is important to eat a snack at this time as it helps flush the isotope through the gastrointestinal tract, allowing us to obtain better images.

Part three starts after your snack. You will be escorted back to the scan room for the second scan. Remember to remain very still during the scan as this affects the results. This scan also takes approximately 15 minutes. After this scan is done the test will be complete.

Two-Day Dobutamine Cardiolite Stress Test

This test has three parts. The three parts will be spread over two days.

In the first part of the test, a nuclear technologist will take you to the testing suite and you will be asked if you have followed the pre-test instructions. An IV (intravenous line) will be started in your arm and the nuclear tech will then inject an isotope so that we can take pictures of your heart. The isotope has no side effects and concentrates in parts of the heart that have the best blood flow. You will be asked to lie down on a special table under a gamma camera to detect the isotope. During imaging, the camera rotates around your body taking pictures of your heart at various angles for about 15 minutes. You must remain STILL while the pictures are being taken. Remaining still is of the utmost importance as it affects the scan critically. This ends part one.

Part two will be on another day. You will meet your nurse and she will explain the next part of the test and answer any questions you have. It is important that you follow your pre-test instructions. These instructions must be followed as certain drugs you might be taking, (dipyridamole, beta-blockers and caffeine), have an adverse affect on the test results and taking them will require the test to be rescheduled. Your blood pressure will be monitored and you will be connected to an electrocardiogram (EKG) machine that will constantly display your heart rhythm and rate. During this part of the test, you will be given a medication called dobutamine which increases the force and rate of your heart's contractions. This medication will be given through your IV line for 8-12 minutes at an increasing rate to raise your heart rate. With this medication you may experience the following side effects:

Rapid heart beat
Chest pressure
Dizziness/light headedness
Mild nausea

When your heart rate has reached its peak, the nuclear medicine technologist will give you another injection of the isotope through the IV line. Once the isotope is injected, the medication will be continued for an additional minute and then stopped. Your EKG and blood pressure will be monitored by the nurse until they return to pre-test levels; usually 15-30 minutes.

After the recovery period you will be disconnected from the EKG machine and you will then have a 30 minute break at which time you will relax and eat the snack you brought. It is important to eat a snack at this time as it helps flush the isotope through the gastrointestinal tract allowing us to obtain higher quality pictures.

Part three starts after your snack. You will be escorted back to the scan room for the second scan. Remember to remain very still during the scan as this affects the results. This scan also takes approximately 15 minutes. After this scan is done, the test will be complete.

Two-Day Exercise Cardiolite Stress Test

This test has three parts and takes place over two days.

For the first part of the test a nuclear technologist will take you to the testing suite and you will be asked if you have followed the pre-test instructions. An IV will be started in your arm and the nuclear tech will inject an isotope so that we can take pictures of your heart. The isotope has no side effects and tends to concentrate in parts of the heart that have the best blood flow. You will be asked to lie down on a special table under a gamma camera to detect the isotope. During imaging, the camera takes pictures of your heart at various angles for about 15 minutes. You must remain STILL while the pictures are being taken. Remaining still is of the utmost importance as it affects the scan critically. This ends part one.

Part two will be on another day. You will meet your treadmill technician and he/she will explain the next part of the test and answer any questions you have. It is important that you follow the pre-test instructions on this day. These instructions must be followed as certain drugs you might be taking (beta-blockers and caffeine) have an adverse affect on the test results and taking them will require the test to be rescheduled. Your blood pressure will be monitored and you will be connected to an Electrocardiogram (EKG) machine that will constantly display your heart rhythm and rate. During this part of the test, you will be walking on a treadmill that increases in speed and elevation every 3 minutes as the test progresses. When we have gotten your heart rate up to its maximum, the nuclear medicine technologist will give you another injection of the isotope through the IV line. Once the isotope is injected, you will exercise for an additional 2 minutes after which the treadmill will be slowed and then stopped. Your EKG and blood pressure will be monitored until they return to pre-test levels, usually 8-10 minutes.

After the recovery period you will be disconnected from the EKG machine and you will then have a 30 minute break at which time you will relax and eat the snack you brought. It is important to eat a snack at this time as it helps flush the isotope through the gastrointestinal tract allowing us to obtain higher quality pictures.

Part three starts after your snack. You will be escorted back to the scan room for the second scan. Remember to remain very still during the scan as this affects the results. This scan also takes approximately 15 minutes. After this scan is done, the test will be complete.

Adenosine Dual Isotope Stress Test

This test has three parts and takes approximately three hours.

In the first part of the test, a nuclear technologist will take you to the testing suite and you will be asked if you have followed the pre-test instructions. These instructions must be followed as certain drugs you might be taking (theophylline, beta-blockers and caffeine) have an adverse affect on the test results. Taking them will require the test to be rescheduled. An IV (intravenous line) will be started in your arm and the nuclear technologist will inject an isotope so that we can take pictures of your heart. The isotope has no side effects and concentrates in parts of the heart that have the best blood flow. You will be asked to lie down on a special table under a gamma camera to detect the isotope. During imaging, the camera takes pictures of your heart at various angles for about 15 minutes. You must remain STILL while the pictures are being taken. Remaining still is of the utmost importance as it affects the scan critically. This ends part one.

Part two starts when the above scan is completed. You will meet your nurse and she will explain the next part of the test and answer any questions you have. You will be connected to an electrocardiogram (EKG) machine that will constantly display your heart rhythm and rate. During this part of the test, you will be given a medication called adenosine via the IV in your arm. The medication is given to expand (dilate) the heart's arteries. Healthy or normal arteries dilate more than partially blocked arteries thus allowing more of the isotope to accumulate in the heart. During the test, you may be asked to walk slowly on a treadmill to help dissipate any side effects. Some patients experience mild side effects with the medication such as:

Feeling a little light-headed
Feeling flushed in the face and chest
Feeling pressure in your throat or chest
Feeling fatigued

After receiving the medication for 2 minutes, a small amount of isotope is again injected into the IV and the medication is continued for 2 more minutes. Once the medication has been stopped, the side effects will disappear within 1 minute. It is important to remember that if you have side effects this does not mean you have heart disease.

After the medication has been stopped, there is a short recovery period and then an approximate 30 minute break at which time you will relax and have the snack you brought. It is important to eat a snack at this time as it helps flush the isotope through the gastrointestinal tract allowing us to obtain better images.

Part three starts after your snack. You will be escorted back to the scan room for the second scan. Remember to remain very still during the scan as this affects the results. This scan also takes approximately 15 minutes. After this scan is done, the test will be complete.

Adenosine Thallium Stress Test

This test has three parts and takes approximately 90 minutes.

To begin the first part of the test, a nuclear technologist will take you to the testing suite and you will be asked if you have followed the pre-test instructions. These instructions must be followed as certain drugs you might be taking, (beta-blockers, theophylline and caffeine), have an adverse affect on the test results. Taking them will require the test to be rescheduled. An IV (intravenous line) will be started in your arm and at this point you will meet your nurse and he/she will explain the next part of the test and answer any questions you have. Your blood pressure will be monitored and you will be connected to an electrocardiogram (EKG) machine that will constantly display your heart rhythm and rate. During this part of the test, you will be given a medication via the IV in your arm. The medication is given to expand (dilate) the heart's arteries. Healthy or normal arteries dilate more than partially blocked arteries thus allowing more isotope to accumulate in the heart. In addition to the medication, you may be asked to walk very slowly on a treadmill for 4 minutes, to help dissipate any side effects. Some patients experience mild side effects with the medication such as:

Feeling a little "light-headed"
Feeling flushed in the face and chest
Feeling pressure in your throat or chest

When the medication has taken effect, after 2 minutes, a small amount of isotope is again injected and the medication is continued for 2 more minutes. Once the medication has been stopped, the side effects will disappear within 1 minute. It is important to remember that if you have side effects this does not mean you have heart disease. Your EKG and blood pressure will be monitored until they return to pre-test levels; 4-6 minutes.

After the recovery period you will be disconnected from the EKG machine and you will be escorted back to the scan room. Remember, remaining still is of the utmost importance as it affects the scan critically. This scan takes approximately 15 minutes. After this scan is done you will be finished with this part of the test. Before you leave, the technologist will give you a time to come back later in the day so that a second set of images can be taken.

For the second part of the test, there is no preparation. When you return, you will be taken back to the camera room and placed on the scanner for another 15 minutes. Once the scan is completed, you will be finished with the test unless your physician has asked for a third set of images on the following day.

Dobutamine Dual Isotope Stress Test

This test has three parts and takes approximately 3 hours. In the first part of the test a nuclear technologist will take you to the testing suite and you will be asked if you have followed the pre-test instructions. These instructions must be followed as certain drugs you might be taking (beta-blockers, dipyridamole and caffeine) have an adverse affect on the test results. Taking them will require the test to be rescheduled. An IV (intravenous line) will be started in your arm and the nuclear technologist will inject an isotope so that we can take pictures of your heart. The isotope has no side effects and concentrates in parts of the heart that have the best blood flow. You will be asked to lie down on a special table under a gamma camera to detect the isotope. During imaging, the camera takes pictures of your heart at various angles for about 15 minutes. You must remain STILL while the pictures are being taken. Remaining still is of the utmost importance as it affects the scan critically. This ends part one.

Part two starts when the above scan is completed. You will meet your nurse and she will explain the next part of the test and answer any questions you have. Your blood pressure will be monitored and you will be connected to an electrocardiogram (EKG), machine that will constantly display your heart rhythm and rate. During this part of the test, you will be given a medication called dobutamine which increases the force and rate of your heart's contractions. This medication will be given through your IV line for 8-12 minutes at an increasing rate to raise your heart rate. With this medication you may experience the following side effects:

Rapid heart beat
Chest pressure
Dizziness/light headedness
Shortness of breath

When your heart rate has reached its peak, the nuclear medicine technologist will give you another injection of the isotope through the IV line. Once the isotope is injected, the medication will be continued for an additional minute and then stopped. Your EKG and blood pressure will be monitored by the nurse until it returns to pre-test levels; usually 15-30 minutes.

After the recovery period you will be disconnected from the EKG machine and you will then have a 30 minute break at which time you will relax and eat the snack you brought. It is important to eat a snack at this time as it helps flush the isotope through the gastrointestinal tract allowing us to obtain higher quality pictures.

Part three starts after your snack. You will be escorted back to the scan room for the second scan. Remember to remain very still during the scan as this affects the results. This scan also takes approximately 15 minutes. After this scan is done, the test will be complete.

Exercise Dual Isotope Stress Test

This test has three parts and takes approximately 3 hours. In the first part of the test a nuclear technologist will take you to the testing suite and you will be asked if you have followed the pre-test instructions. These instructions must be followed as certain drugs you might be taking (beta-blockers and caffeine) have an adverse affect on the test results. Taking them will require the test to be rescheduled. An IV (intravenous line) will be started in your arm and the nuclear technologist will inject an isotope so that we can take pictures of your heart. The isotope has no side effects and concentrates in parts of the heart that have the best blood flow. You will be asked to lie down on a special table under a gamma camera to detect the isotope. During imaging, the camera takes pictures of your heart at various angles for about 15 minutes. You must remain STILL while the pictures are being taken. Remaining still is of the utmost importance as it affects the scan critically. This ends part one.

Part two starts when the above scan is completed. You will meet your treadmill technician and he/she will explain the next part of the test and answer any questions you have. Your blood pressure will be monitored and you will be connected to an electrocardiogram (EKG) machine that will constantly display your heart rhythm and rate. During this part of the test, you will be walking on a treadmill that increases in speed and elevation every 3 minutes as the test progresses. When we have gotten your heart rate up to its maximum, the nuclear medicine technologist will give you another injection of the isotope through the IV line. Once the isotope is injected, you will exercise for an additional 2 minutes after which the treadmill will be slowed and then stopped. Your EKG and blood pressure will be monitored until they return to pre-test levels, usually 8-10 minutes.

After the recovery period you will be disconnected from the EKG machine and you will then have a 30 minute break at which time you will relax and eat the snack you brought. It is important to eat a snack at this time as it helps flush the isotope through the gastrointestinal tract allowing us to obtain higher quality pictures.

Part three starts after your snack. You will be escorted back to the scan room for the second scan. Remember to remain very still during the scan as this affects the results. This scan also takes approximately 15 minutes. After this scan is done, the test will be complete.

Exercise Thallium Stress Test

This test has three parts and takes approximately 90 minutes. In the first part of the test a nuclear technologist will take you to the testing suite and you will be asked if you have followed the pre-test instructions. These instructions must be followed as certain drugs you might be taking, (Beta-Blockers and Caffeine), have an adverse affect on the test results. Taking them will require the test to be rescheduled. An IV (intravenous line) will be started in your arm and at this point you will meet your treadmill technician and he/she will explain the next part of the test and answer any questions you have. Your blood pressure will be monitored and you will be connected to an electrocardiogram (EKG), machine that will constantly display your heart rhythm and rate. During this part of the test, you will be walking on a treadmill that increases in speed and elevation every 3 minutes as the test progresses. When we have gotten your heart rate up to its maximum, the nuclear medicine technologist will give you an injection of the isotope through the IV line. The isotope has no side effects and concentrates in parts of the heart that have the best blood flow. Once the isotope is injected, you will exercise for an additional 1 minute after which the treadmill will be slowed and then stopped. Your EKG and blood pressure will be monitored until they return to pre-test levels; 4- 6 minutes.

After the recovery period you will be disconnected from the EKG machine and you will be escorted back to the scan room. Remember, remaining still is of the utmost importance as it affects the scan critically. This scan takes approximately 15 minutes. After this scan is done you will be finished with this part of the test.

When the scan is finished, the technologist will give you a time to come back later in the day for the second part where a second set of images will be taken. For this second scan, there is no preparation. When you return for the second scan, you will be taken back to the camera room and placed on the scanner for another 20 minutes. Once the scan is completed, you will be finished with the test unless your physician has asked for follow-up images on the following day.

Nitroglycerin Enhanced Thallium Stress Test

This test has two parts and takes approximately 60 minutes. In the first part of the test a nuclear technologist will take you to the testing suite and you will be asked if you have followed the pre-test instructions. These instructions must be followed as certain drugs you might be taking (beta-blockers, caffeine, Viagra, Cialis, and the like) have an adverse affect on the test results. Taking them will require the test to be rescheduled. An IV (intravenous line) will be started in your arm and at this point you will meet your treadmill technician and he/she will explain the next part of the test and answer any questions you have. Your blood pressure will be monitored and you will be connected to an electrocardiogram (EKG), machine that will constantly display your heart rhythm and rate. During this part of the test, you will be given oral nitroglycerin to dilate the blood vessels of your heart. When we have gotten the desired effect on your heart, the nuclear medicine technologist will give you an injection of the isotope through the IV line. The isotope has no side effects and concentrates in parts of the heart that have the best blood flow. Once the isotope is injected, you will be positioned on the scanner and the camera will begin to take images. Remember, remaining still is of the utmost importance as it affects the scan critically. This scan takes approximately 15 minutes. After this scan is done you will be finished with this part of the test.

When the scan is finished, the technologist will give you a time to come back later in the day so that a second set of images can be taken. For this Second part, there is no preparation. When you return, you will be taken back to the camera room and placed on the scanner for another 20 minutes. Once the scan is completed, you will be finished with the test unless your physician has asked for follow-up images on the following day.