Risks And Contraindications Of A Nuclear Stress Test
When performed by experienced providers, the nuclear stress test is very safe. Still, there are known risks.
Possible risks of having a nuclear stress test that you should be aware of include:
- Cardiac arrhythmias: Exercise-induced heart arrhythmias are when your heart beats too fast, too slow, or irregularly. Arrhythmias are usually not dangerous. They almost always go away when the person stops exercising. While arrhythmias are a risk of stress testing, their presence can also help with diagnosis. If you’re worried about them, keep in mind that if dangerous arrhythmias happen during modest exercise, the safest way to find out about them is in a controlled setting under the care of a provider.
- Chest pain, dizziness, or other symptoms: In people with serious CAD, modest exercise can cause symptoms of insufficient blood flow to the heart muscle . While it is a risk of the test, it can also be useful for providers to see exercise-related symptoms during the test. In fact, in people who are being assessed for exercise-related symptoms, one of the goals is to reproduce the symptoms during the test.
- Allergic reaction: Some people may have an allergic reaction to the radioactive tracer, but this is very rare.
- Heart attack: It’s very rare, but if a person has a critical blockage, exercise might produce a heart attack.
Life-threatening complications rarely happen during a nuclear stress test. They are estimated to occur only in 1 out of every 10,000 exercise tests.
Purpose Of The Nuclear Stress Test
A nuclear stress test helps your healthcare provider visualize what is happening in your heart when you exercise. A nuclear stress test is different than a regular stress test. A regular stress test uses an ECG to record your heart rate and rhythm, while a nuclear stress test captures images of your heart.
Your provider may order a nuclear stress test if you have certain symptoms of CAD, such as:
If you already have been diagnosed with CAD, your provider might want you to have the test because the results can help them come up with a treatment plan for you.
If you are being treated for CAD, the test can help your provider understand how well your treatment is working. It will also help your provider decide what kinds of daily activities and exercise you should be doing.
The nuclear stress test does not involve inserting medical instruments into your body. This means it is non-invasive.
The test is thought to be the most accurate and non-invasive way to diagnose coronary artery blockages.
CAD can also be diagnosed with an invasive test called cardiac catheterizationâa procedure where a tube called a catheter is inserted into a blood vessel in the heart.
If you can have a nuclear stress test, you may not need to have cardiac catheterization.
Side Effects And Precautions After Nuclear Stress Test
A nuclear stress test is an investigation which studies the functioning of your heart under stress conditions with the use of radioactive isotopes which is injected into the system.
The test is divided into two parts. In the first part, images of the heart are taken under rest conditions and in the second part of the test the subject is made to undergo physical or pharmacological stress and then images are once again acquired.
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Radiation In Healthcare: Nuclear Medicine
Nuclear medicine uses radioactive material inside the body to see how organs or tissue are functioning or to target and destroy damaged or diseased organs or tissue .
Nuclear medicine vs common imaging procedures using x-rays: how they work
|Radioactive material is injected, ingested, or inhaled
|Beams of radiation pass through the body
|Images of the body show where and how the tracer is absorbed.
|Images of the structure in the body are produced
|Used in diagnosis or treatment
|Used in diagnoses
Although we all are exposed to ionizing radiation every day from the natural environment, added exposures like those from nuclear medicine procedures can slightly increase the risk of developing cancer later in life.
Talk to your healthcare provider to decide on the best procedure for your health needs and discuss any concerns you have.
How Does A Pharmacological Nuclear Stress Test Work
There are two parts to this test, during which providers take two sets of images. During a pharmacological nuclear stress test, healthcare providers:
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What Are The Benefits Of A Nm Cardiac Stress Test
The NM cardiac stress test is a non-invasive , low-risk study that allows your doctor to assess the presence of significant coronary artery disease and how well your heart muscle is working. It is very good at assessing the likelihood of the risk that you will experience a significant cardiac event and the importance of other clinical findings.
Reducing Radiation Exposure From Nuclear Myocardial Perfusion Imaging: Time To Act Is Now
Over the past two decades there has been approximately 60% increase in the number of outpatient cardiac stress tests in the US . In 2010, around 87% of these stress tests were done with concordant use of imaging. The bulk of growth in cardiac imaging has been due to a rising use of nuclear stress testing . Increased emphasis on appropriate use criteria, may have led to a slight decline in nuclear myocardial perfusion imaging , however, it still maintains its place as the workhorse for cardiac stress testing.
Median Effective Dose for Myocardial Perfusion Imaging by Country INCAPS 2013 Surveya
From IAEA Nuclear Cardiology Protocols Cross-Sectional Study 2013 Survey. A median effective dose of 9 mSv is recommended. Arrows point to median effective doses from Japan and US.
aAdapted from Einstein et al. under the terms of the Creative Commons Attribution Non-Commercial License
Are Any Health Effects Associated With Nuclear Medicine Procedures
The Nuclear Regulatory Commission , the U.S. Food and Drug Administration and states regulate the use of radioactive materials for nuclear medicine to make sure patients, medical personnel, and the public are safe. Before any type of nuclear medicine procedure is used, it must be justified to ensure the benefits of the procedures outweigh risks to the patient. However, exposure to too much radiation can quickly damage organs or tissues, while exposure to any amount of radiation might lead to an increase in the risk of cancer years after the exposure occurs. Image Gentlyexternal icon is a campaign that encourages medical facilities to use a child size amount of radioactive material when a child has a nuclear medicine procedure.
What Is A Cardiac Pet Scan
A PET scan of the heart is a noninvasive nuclear imaging test. It uses radioactive tracers to produce pictures of your heart. Health care professionals use cardiac PET scans to diagnose coronary artery disease and damage due to a heart attack. PET scans can show healthy and damaged heart muscle. PET scans are also used to help find out if you will benefit from a percutaneous coronary intervention such as angioplasty and stenting, coronary artery bypass surgery or another procedure.
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What Are The Precautions After A Nuclear Stress Test
You do not need to take any precautions. The injected radio isotope usually will not cause any adverse effects in most individuals.
The medications used to induce pharmacological stress are adenosine, dipyridamole and dobutamine and any one of the medications is used. These medications cause dilatation of blood vessels and open up the arteries of the heart to increase the blood supply and simulates post exercise functioning of the heart.
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What Are Nuclear Medicine Procedures
Nuclear medicine procedures are used in diagnosing and treating certain illnesses. These procedures use radioactive materials called radiopharmaceuticals. Examples of diseases treated with nuclear medicine procedures are hyperthyroidism, thyroid cancer, lymphomas, and bone pain from some types of cancer.
The amount of radioactive materials used in diagnosing illnesses depends on the needs of the person and range from a small amount to a large amount. These materials flow through different body organs and in some cases are taken up by specific organs or tissue. The radiation that comes from the radiopharmaceutical is used for treatment or is detected by a camera to take pictures of the corresponding body organ, region or tissue.
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Patients Are Carefully Monitored
Patients are constantly monitored during and after a nuclear stress test. If the doctor administering the test notices anything out of the ordinary, the test will be stopped immediately.
If a patient completes a nuclear test and that test wasnt interrupted, then its safe to leave the testing site. However, if the patient experiences cardiac stress or chest pain, then it is important to seek immediate medical attention.
Tracers that are injected into the patient, though radioactive, dont pose an allergic threat to anyone who is commonly allergic to iodine or to the contrast dye used in CAT scans. However, there are chemicals attached to the radioactive isotopes which, in extremely rare cases, can cause an allergic reaction.
Pay attention to how you feel following a nuclear stress test. If you do experience anything that concerns you, as with any other abnormal or allergic reaction, seek medical attention right away.
Exposure To Ionizing Radiation On The Rise
The radiation you get from x-ray, CT, and nuclear imaging is ionizing radiation high-energy wavelengths or particles that penetrate tissue to reveal the body’s internal organs and structures. Ionizing radiation can damage DNA, and although your cells repair most of the damage, they sometimes do the job imperfectly, leaving small areas of “misrepair.” The result is DNA mutations that may contribute to cancer years down the road.
We’re exposed to small doses of ionizing radiation from natural sources all the time in particular, cosmic radiation, mainly from the sun, and radon, a radioactive gas that comes from the natural breakdown of uranium in soil, rock, water, and building materials. How much of this so-called background radiation you are exposed to depends on many factors, including altitude and home ventilation. But the average is 3 millisieverts per year.
Exposure to ionizing radiation from natural or background sources hasn’t changed since about 1980, but Americans’ total per capita radiation exposure has nearly doubled, and experts believe the main reason is increased use of medical imaging. The proportion of total radiation exposure that comes from medical sources has grown from 15% in the early 1980s to 50% today. CT alone accounts for 24% of all radiation exposure in the United States, according to a report issued in March 2009 by the National Council on Radiation Protection and Measurements.
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Radiation Risk From Medical Imaging
There’s always questions about radiation exposure from medical imaging. Patients want to know if radiation from mammograms, bone density tests, computed tomography scans, and so forth will increase their risk of developing cancer. For most women, there’s very little risk from routine x-ray imaging such as mammography or dental x-rays. But many experts are concerned about an explosion in the use of higher radiationdose tests, such as CT and nuclear imaging.
Over 80 million CT scans are performed in the United States each year, compared with just three million in 1980. There are good reasons for this trend. CT scanning and nuclear imaging have revolutionized diagnosis and treatment, almost eliminating the need for once-common exploratory surgeries and many other invasive and potentially risky procedures. The benefits of these tests, when they’re appropriate, far outweigh any radiation-associated cancer risks, and the risk from a single CT scan or nuclear imaging test is quite small. But are we courting future public health problems?
Are There Any After Effects Of A Nm Cardiac Stress Test
If you are to do a treadmill exercise stress test as part of this scan, you might feel tired after the exercise, but the radiopharmaceuticals themselves do not cause any side-effects.
If you are unable to have a stress test on a treadmill, then one of three types of medications, dipyridamole , adenosine or dobutamine, might be given intravenously to increase blood flow in your heart.
Dipyridamole works by causing the heart arteries to dilate . There are multiple potential side effects:
- a warm sensation in the face
- might make asthma worse
- in cases of significant coronary artery disease, it might induce a heart attack, although the risk of this adverse event is low.
If symptoms of headache persist, a caffeinated beverage such as tea or coffee is recommended and should relieve the headache. You might be given another medication called aminophylline, which acts to reverse the side-effects of dipyridamole if they do not resolve quickly.
An alternative drug, adenosine, works in a similar manner to dipyridamole. Side-effects similar to dipyridamole might be experienced. Symptoms of chest pain or pressure can also occur, but these side-effects go away quickly once the adenosine has been given.
These side-effects should disappear shortly after the stress test and before you leave the NM facility .
If you are breast-feeding or caring for young children, see the How do I prepare section for more information about special precautions you might need to take.
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Results And Next Steps
Normal results from a nuclear stress test are typically a good indicator that there is no significant cardiovascular problem that needs immediate attention. Abnormal results will require further diagnosis and/or treatment that will be discussed with your cardiologist. Some patients may be referred for a cardiac catheterization, which is a procedure to see if there are any blockages in the arteries that supply the heart muscle with blood. Depending on the results of the catheterization, you may need stents to open up the blocked arteries. Significant blockage in the arteries may require a bypass procedure. Milder problems may only require watchful waiting or medication.
Nuclear stress testing is a very safe and easy diagnostic procedure that allows your physician to diagnose coronary artery disease. Please call the office if you have any questions or concerns about your nuclear stress test.
Cardiac Nuclear Stress Testing At Nmc Health
At NMC Health, we care about your heart. When something isnt quite right, there are tests you can do to see whats going on. One test your doctor might order is a cardiac nuclear stress test. The test is done in the imaging department.
Cardiac nuclear medicine stress tests are for people who have unexplained chest pain or chest pain during exercise . A cardiac nuclear stress test can pinpoint early heart disease.
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Types Of Stress Tests
Pictures are taken with special cameras . Areas of your heart will light up on the image because of the radioactive dye. Your heart can be stressed with the help of exercise, medicine or both.
The most common cardiac stress test procedure is called myocardial perfusion imaging. It allows heart specialists to see how your blood flows to the heart walls. This test is important for finding and locating heart blockages caused by coronary artery disease. It also can show any damage to the heart after you experience a heart attack .
After Your Nuclear Stress Test
Most people can go back to their normal routine immediately after the test. This includes having meals, taking medications, and doing other activities.
The amount of radiation you receive during this test is considered very small. There are no special precautions you will need to take afterward.
How and when you get your results depends on the testing center. Most laboratories will give you an overview of the results right away. If the test finds problems, you’ll be given advice on what to do next.
If there are no obvious problems, you likely will not get the formal results of the test until a cardiologist looks at the images.
In this case, you’ll get your results from the provider who ordered the test. From there, you’ll discuss what, if anything, should be done next.
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What To Expect: Nuclear Stress Testing
A nuclear stress test is an advanced diagnostic tool for finding the cause of new or worsening chest pain, stratifying risk for heart disease, deciding how well treatment is progressing, and/or evaluating recovery after a heart attack. Most of the stress tests performed by Heart House physicians are done in the office. A regular stress test shows the EKG, heartrate and blood pressure while you are walking on a treadmill. A nuclear stress test shows your physician pictures of the blood flow to the heart muscle, in addition to the EKG, heartrate and blood pressure.
In order to take the pictures of your heart, you will receive an injection of a radioactive tracer through an IV. The tracer allows the Nuclear camera to take pictures of the blood flow to the heart muscle. There are no side effects from the radioactive tracer. It is not a contrast dye. It does not contain iodine and will not harm your kidneys. Nuclear stress testing, is very safe and can help your cardiologist accurately diagnosis heart disease.
Patient Information / Faq
- Will I be allergic to the radioactive dose? If so, who should I call if I develop a reaction?Allergy to radioactivity does not exist. In very rare cases there can be an allergic reaction to the chemical to which the radioactive isotope is attached to. If you should have an allergic reaction the Nuclear Medicine Physician will treat you. Be sure to notify the staff of any allergies or allergic reactions you have had in the past.
- How long will the radioactivity stay in my system?With most of the tracers used, the radioactivity will be almost completely gone by the following day.
- Is it dangerous to be around others, especially around children or pregnant women?Except for patients being treated with radioactive isotopes there is no risk in exposing others to dangerous amounts of radioactivity.
- What precautions should I take after receiving a radioactive dose?You do not need to take any precautions.
- What does the radioactive dose do?The radioactive dose is attached to a molecule which goes to the organ system that needs to be imaged. A special camera records the radioactivity coming out of the body and from the organ. A computer then creates an image which will be read by the Nuclear Medicine Physician.
- When can I or my physician expect to receive the results of my exam?Images are usually read the same day and the results should be available to your physician within 36 hours.
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