ASNC Patient Awareness Brochures

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General Information for Patients

DISCLAIMER: This document is intended for informational purposes only. The material provided is for the patient's understanding of the procedures discussed. The document does not reference medical difficulties or complications that may result from undergoing the procedure. All such matters should be discussed by the patient and the doctor. This document should not be considered to be, or utilized as, an informed consent document. Heart disease, including coronary artery disease, is the leading cause of death in the USA. Nuclear cardiology studies are used for the evaluation of coronary heart disease and the assessment of the function of the heart muscle. The following information provides a general overview of a few of the nuclear cardiology tests that may be ordered by your doctor to help determine if you have coronary artery disease or a problem with the heart muscle.

What is Coronary Artery Disease?

Coronary artery disease results from the narrowing of the blood vessels that supply the heart. The blood vessels become narrow when fatty deposits build up inside the blood vessel wall. This is the process of atherosclerosis. When the arteries become clogged, the blood flow to the heart muscle is reduced and a heart attack can occur.

Nuclear Cardiology

Nuclear cardiology studies use small doses of radioactive material to assess myocardial blood flow, evaluate the pumping function of the heart as well as visualize the size and location of a heart attack. Among the types of nuclear cardiology studies, myocardial perfusion imaging is the most widely used.

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Exercise Stress Test with Imaging

The following information is a general guideline only and does not take the place of talking about the test or any questions you may have with your doctor or the people performing the test.

Indications

The purpose of this test is to assess the regional blood flow to the heart muscle both at stress and at rest and compare the two images to each other to allow an assessment of prior damage to the heart muscle (myocardial infarction) or a lack of enough blood flow to the heart muscle during exercise (myocardial ischemia). The test will be ordered by your doctor and is usually ordered to assess chest pain or other symptoms that may be related to your heart.

The test is not appropriate in patients who cannot exercise safely due to orthopedic problems, have severe aortic stenosis, or other medical problems that do not allow you to exercise.

Preparation
You should feel free to ask questions of anyone at anytime during the test.

You will be asked to not eat for a few hours prior to coming for your test. This time will vary depending upon the type of test you are having, the time of day of the test and your medical condition, such as diabetes. The laboratory where you are having the test should provide you with this information when they set up your appointment.

You should arrive a few minutes early to allow completion of the necessary paperwork prior to testing.

You should wear comfortable clothes to exercise in. This includes comfortable loose clothing and comfortable shoes to walk/run in.

Procedure
After explaining the test to you and getting your permission to continue the staff will place a small tube in a vein in your arm to allow us to give you the necessary injections.

Depending on the procedure used by the laboratory where you are having your test, it may be done on a single day or on two days. You will usually have two sets of images acquired - one following exercise and one following a period of rest. These will be acquired utilizing a radioactive material that has been injected into your vein that allows us to take a picture of the blood flow at the time of injection. These pictures are taken while you are lying down under a special camera that allows us to take a picture of the radioactivity coming from your heart. Additionally, you may have some electrocardiogram (ECG) electrodes attached to your body so that we can monitor your heart rate during the images. Each set of pictures takes between 15-30 minutes depending on the camera that is used.

You will have an exercise test performed where you will walk on a treadmill while having your electrocardiogram (ECG) monitored by a qualified staff person. It is important to let the staff know if you are having any symptoms during the test to allow them to better assess when to stop the test. They will ask you to judge when you think you only have a minute left to exercise to allow them to time the radioactive injection correctly to allow them to assess your maximal exercise level.

You may experience shortness of breath, chest or arm pain or discomfort, difficulty walking, fatigue or other symptoms during or after the test. It is important for you to let the person performing the test know how you feel so that they can respond as needed.

Report
Your test will be read by a physician experienced in the interpretation of this type of test. The report will be sent your doctor who ordered the test and can help interpret the findings for you in light of your unique clinical findings.

Adenosine Injection or Dipyridamole Test with Imaging

The following information is a general guideline only and does not take the place of talking about the test or any questions you may have with your doctor or the people performing the test.

Indications/contraindications
The purpose of this test is to assess the regional blood flow to the heart muscle both at stress and at rest and compare the two images to each other to allow an assessment of prior damage to the heart muscle (myocardial infarction) or a lack of enough blood flow to the heart muscle during exercise (myocardial ischemia). The test will be ordered by your doctor and is usually ordered to assess chest pain or other symptoms that may be related to your heart.

The test is not appropriate in patients who have asthma. Patients who use medications containing theophylline must be able to stop them for at least 48 hours prior to the test.

Preparation
You should feel free to ask questions of anyone at anytime during the test.

You will be asked to not eat for a few hours prior to coming for your test. This time will vary depending upon the type of test you are having, the time of day of the test and your medical condition, such as diabetes. You should not consume any caffeine containing products for at least 12-24 hours prior to the test. This includes coffee, tea, soft drinks containing caffeine, and chocolate as examples. The laboratory where you are having the test should provide you with this information when they set up your appointment.

You should arrive a few minutes early to allow completion of the necessary paperwork prior to testing.

You should wear comfortable clothes. This includes comfortable loose clothing and comfortable shoes to walk in, as you may be asked to exercise minimally.

Procedure
After explaining the test to you and getting your permission to continue the staff will place a small tube in a vein in your arm to allow us to give you the necessary injections.

Depending on the procedure utilized by the laboratory where you are having your test, it may be done on a single day or on two days. You will usually have two sets of images acquired - one following administration of either dipyridamole or adenosine and one following a period of rest. These will be acquired utilizing a radioactive material that has been injected into your vein that allows the technologist to take a picture of the blood flow at the time of injection. These pictures are taken while you are lying down under a special camera that allows the technologist to take a picture of the radioactivity coming from your heart. Additionally, you may have some electrocardiogram (ECG) electrodes attached to your body so that we can monitor your heart rate during the images. Each set of pictures takes between 15-30 minutes depending on the camera that is used.

You will have a chemical stress test performed where you will be given a medication, either dipyridamole or adenosine, through a vein while having your electrocardiogram (ECG) monitored by a qualified staff person. It is important to let the staff know if you are having any symptoms during the test to allow them to better assess when to stop the test. You may be asked to exercise minimally following the injection to improve the quality of the study and lessen any potential side effects.

You may experience chest pain, palpitations, headache or a flushing feeling during the test. You may also feel short of breath. You should let the person performing the test know about these and any other symptoms you may experience during the test.

You may receive an additional injection of a drug called aminophylline depending on the procedures of the nuclear medicine department where the test is performed. You may also receive this if you are having a side effect from the dipyridamole or adenosine.

Report
Your test will be read by a physician experienced in the interpretation of this type of test. The report will be sent your doctor who ordered the test and can help interpret the findings for you in light of your unique clinical findings.

Back to Study Types

Dobutamine Test with Imaging

The following information is a general guideline only and does not take the place of talking about the test or any questions you may have with your doctor or the people performing the test.

Indications/contraindications
The purpose of this test is to assess the regional blood flow to the heart muscle both at stress and at rest and compare the two images to each other to allow an assessment of prior damage to the heart muscle (myocardial infarction) or a lack of enough blood flow to the heart muscle during exercise (myocardial ischemia). The test will be ordered by your doctor and is usually ordered to assess chest pain or other symptoms that may be related to your heart.

The test may not be appropriate in patients who have had a recent heart attack, or who have glaucoma or irregular heart rhythms. If you have theses conditions please discuss this with the physician ordering the test. Some patients may be asked to stop taking a certain kind of medication (beta -blockers) by their physician prior to the test.

Preparation
You should feel free to ask questions of anyone at anytime during the test.

You will be asked to not eat for a few hours prior to coming for your test. This time will vary depending upon the type of test you are having, the time of day of the test and your medical condition, such as diabetes. The laboratory where you are having the test should provide you with this information when they set up your appointment.

You should arrive a few minutes early to allow completion of the necessary paperwork prior to testing.

You should wear comfortable clothes. This includes comfortable loose clothing.

Procedure
After explaining the test to you and getting your permission to continue the staff will place a small tube in a vein in your arm to allow us to give you the necessary injections.

Depending on the procedure utilized by the laboratory where you are having your test, it may be done on a single day or on two days. You will usually have two sets of images acquired - one following administration of dobutamine and one following a period of rest. These will be acquired utilizing a radioactive material that has been injected into your vein that allows the technologist to take a picture of the blood flow at the time of injection. These pictures are taken while you are lying down under a special camera that allows the technologist to take a picture of the radioactivity coming from your heart. Additionally, you may have some electrocardiogram (ECG) electrodes attached to your body so that we can monitor your heart rate during the images. Each set of pictures takes between 15-30 minutes depending on the camera that is used.

You will have a chemical stress test performed where you will be given a medication, dobutamine, through a vein while having your electrocardiogram monitored by a qualified staff person. It is important to let the staff know if you are having any symptoms during the test to allow them to better assess when to stop the test. Atropine may be given intravenously in order to further increase your heart rate.

During the test you may experience chest or arm pain or discomfort, palpitations, or other symptoms. It is important to let the person performing the test know about any symptoms you may be having so that they can determine when to stop the test. The person performing the test may need to take other measures to make you more comfortable.

Report
Your test will be read by a physician experienced in the interpretation of this type of test. The report will be sent your doctor who ordered the test and can help interpret the findings for you in light of your unique clinical findings.

Back to Study Types

Evaluation of Cardiac Function

Radionuclide angiography and equilibrium radionuclide ventriculography also known as radionuclide ventricular function studies are noninvasive studies which provide information about the pumping function of the heart. Two types of studies are performed: a) Equilibrium Gated Blood Pool Study and b) First Pass Study

Gated Blood Pool Study with Rest/ Exercise

Gated blood pool study, also referred to as a MUGA study, provides information about the blood flow in the heart and the pumping function of the heart during rest and or exercise. This test may be ordered as a Rest Gated Blood Pool Study alone or it can be combined with exercise as an Exercise Gated Blood Pool Study.

Indications
To provide information about the assessment of the pumping function of the heart (also known as the ejection fraction). This test may also be requested by your doctor to monitor for heart muscle damage after certain types of chemotherapy drugs have been administered or to assess the pumping function after a heart attack.

Preparation
Do not eat or drink four hours prior to the test. You should arrive a few minutes early to allow completion of the necessary paperwork prior to testing. Your doctor may request that you have only a rest study or a rest and exercise gated blood pool study. Wear comfortable shoes and clothing since you may be required to exercise as part of the test.

Please talk to your physician regarding which medications should be taken prior to the test.

Procedure

Rest Study
ECG pads will be placed on the chest for an electrocardiogram. A small tube will be placed into an arm vein and the imaging agent will be injected into this tube. Images will be acquired for the resting part of the study. The nuclear medicine camera takes a series of images of the blood moving through the heart and records the motion of the heart at rest.

Exercise Study
This study usually follows the rest study.

You will be asked to exercise on a stationary bicycle while the nuclear medicine camera measures the blood flow in your heart. You will remain connected to the ECG and recordings will be made during the test. The doctor or nurse who is present during the exercise test will monitor your blood pressure and heart rate.

You will be encouraged to keep exercising for as long as you can depending on your heart rate, ECG and blood pressure. It is important to let the staff know if you are having any symptoms during the test to allow them to better decide when to stop the test.

Report
A physician experienced in the interpretation of gated blood pool studies will read your test. The report will be sent to your referring doctor.

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First Pass Rest Study and Exercise First Pass Study

The First Pass Rest Flow study is used to measure the blood flow through the blood vessels and chambers of the heart. This study may be performed in several phases during both rest and exercise. The differences in the blood flow through the heart at rest and exercise can help evaluate the pumping function of the four chambers of the heart as well as detect changes in blood flow which may occur only with exercise.

Indications

1. Evaluation of the Left and Right Ejection Fraction (Pumping function of the heart) at rest and exercise.
2. Detection and monitoring of abnormal blood flow through the valves or chambers of the heart.

Preparation
Do not eat or drink four hours prior to the test. You should arrive a few minutes early to allow completion of the necessary paperwork prior to testing. Wear comfortable shoes and clothing, since you will be required to exercise as part of this test.

Please consult your physician regarding which medications should be taken prior to the test.

The Rest Study
ECG pads will be placed on the chest for an electrocardiogram. A small tube will be placed into an arm vein and the imaging agent will be injected into this tube, while images are acquired by the gamma camera. The nuclear medicine camera takes a series of images of the blood moving through the heart and records the motion of the heart at rest.

The Exercise Study
Prior to the exercise study, ECG pads are attached to the chest and the ECG wires are connected to the ECG machine, which monitors the heart rhythm during the test. A small tube will be placed into an arm vein and the imaging agent will be injected into this tube. You will then be required to exercise on a stationary bicycle or a treadmill, while images are acquired by the nuclear medicine camera during exercise.

The doctor or nurse who is present during the exercise test will monitor your blood pressure and heart rate. You will be encouraged to keep exercising for as long as you can depending on your heart rate, ECG and blood pressure.

It is important to let the staff know if you are having any symptoms during the test to allow them to better assess when to stop the test.

Report
A physician experienced in the interpretation of first pass studies will read your test. The report will be sent to your referring doctor.

This program has been made possible by the generous support of Astellas Pharma US, Inc.