Preparation for a Treadmill Exam or Pharmacological Stress Study

Instructions For Patients Undergoing Exercise Treadmill Or Pharmacologic Provocation Stress Testing With Myocardial Perfusion Imaging

You have been scheduled to have an exercise treadmill or pharmacologic provocation stress test with myocardial perfusion imaging performed at the Suncoast Heart Institute Cardiac Imaging Center.

A radiopharmaceutical is used during this study for cardiac imaging. A radiopharmaceutical is an imaging agent that is special-ordered, and prepared specifically for you, several hours before its use. This material undergoes spontaneous radioactive decay, and must be used within the specific time frame for which it is designated. Once ordered, your dose cannot be used for anyone else. You must notify our office at-least 24-hours in advance if you are unable to keep this appointment, so that there is adequate time to cancel your radiopharmaceutical doses.

You may not have any food to eat for at-least 6 hours prior to your arrival time. You may drink clear liquids along with your regular medications on the morning of your study. It is recommended (for diabetic patients) that you do not take any of your oral diabetic medications in the morning on the day of your procedure. If you use insulin for blood-sugar control, you should anticipate that we will ask you to cut the dose of insulin that you usually take in the morning in half on the day of your procedure. If you have not been contacted by a member of our staff providing you with diabetic medication instructions prior to your procedure, please call the Suncoast Heart Institute office (941) 313-3393 during regular office hours to confirm your medication instructions, at-least 48-hours in advance of your scheduled diagnostic procedure.
You must avoid drinking tea, coffee, or any other beverages or foods that contain caffeine (including certain soft drinks and energy drinks) for a minimum of 24-hours prior to your procedure. Please note that “decaf coffee” has a reduced amount of caffeine – but is generally not fully “caffeine-free”, and therefore is also to be avoided. Caffeine is also present in chocolate, and therefore, foods containing chocolate need to be avoided, as well. Caffeinated drinks or other products containing caffeine have the potential to interfere with the accurate results of your study.
Caffeine-containing medications should also not be taken for at-least 24-hour prior to your procedure. These medications include: certain diet supplements, Anacin, Arthriten, BC Fast Pain Relief/Arthritis, Caffedrine, Cope, Coryban-D, Dristan, Excedrin, Midol, Migrol, No-Doze, Triaminicin, Vanquish, Vivarin, Cafergot, Esgic, Fiorinal, Fioricet, Norgesic, Synalgos-DC, and Wigraine.
Medications containing dipyridamole (Persantine, Aggrenox), and medications containing theophylline will need to be discontinued for 24-hour prior to your study.
If you have breathing problems (COPD, chronic bronchitis, emphysema, asthma, or wheezing), or if you use specific medications for lung disease, please call our office prior to your study and inform our staff what medications you are taking. This information may result in the need to change the type of test that you are to receive.
If you take any medications that could reduce your heart rate (beta-blockers or verapamil), these medications will need to be discontinued at-least 24-hours in advance of your exercise study. Beta-blockers include: metoprolol (Lopressor, Toprol XL), timolol (Blocadren, Betimol, Cosopt, Timoptic, Timolide), propranolol (Inderal, Innopran), nadolol (Corgard), atenolol (Tenormin), labetalol (Trandate, Normodyne), levobunolol (Betagan), pindolol (Visken), betaxolol (Betoptic, Kerlone), carteolol, carvedilol (Coreg), nebivolol (Bystolic), and metipranolol (Optipranolol). Brand products containing Verapamil include: Calan, Covera, Isoptin, and Verelan.
Please bring an updated complete list of your medications with you. Wear comfortable clothing and shoes. Wear loose fitting slacks or shorts, a shirt or blouse with buttons in front, sneakers, or walking shoes. Do not wear shirts or blouses with any metal snaps or buttons. Women should not wear a bra containing a metal under-wire.
Shower or bathe on the morning of your study. Do not apply any lotions, powders, or oils to your body on the morning of your study. If you have any physical limitations or injuries, please inform our office at-least 48-hours in advance of your scheduled procedure time.
You will be required to remain in our facility for at-least 1-hour to have your study completed (if you are to have nuclear imaging done with exercise treadmill testing or pharmacologic provocation testing). Please allow sufficient time on your schedule to accommodate this time requirement.
Bring a bottle of water and a light snack along with you. You will be allowed to eat and drink after your initial set of images (when OK’d by our nuclear technician).
If your insurance requires a referral, you must bring it along with you on the day of your study.

Regarding Radioactivity

Diagnostic nuclear cardiac imaging studies requires the administration of a low-dose of a radioactive isotope. The nuclear imaging agents used in most hospitals are standard thallium or technecium compounds. These radioisotopes have been used as medical diagnostic imaging agents for many years, without any specific adverse long-term effects from the radioactivity received ever having been reported. PET studies performed on our premises use rubidium-82 (Rb) as an intravenous imaging agent. You can remain assured that the smallest possible amount of radioactivity to perform the study satisfactorily is being used. The amount of radioactivity received (per study) is approximately equivalent to 1-2 years of natural (background) radiation, or the equivalent of one or two chest x-rays. No special precautions are needed for the patient or companion(s) once the test has been completed.

Patients who are pregnant, might be pregnant, or are nursing, should not receive radioactivity, and should inform our staff of their status prior to their test, so that alternative arrangements can be made.

Results

Cardiac studies performed at the Suncoast Heart Institute Cardiac Imaging Center will be given to a board-certified cardiologist to interpret (usually within 24-48 hours). An official report will be generated and will be sent to your family physician, referring physician, or other requesting health care provider. If you require extra copies of your reports to be sent to any other physicians or health care providers, please inform our staff of exactly how many copies you will need, and who they are to be sent to. You should have available the correct addresses and telephone numbers (including the FAX number[s]) for these individuals at the time of your request.

Myocardial perfusion imaging studies are primarily designed to detect myocardial ischemia. For any positive finding of ischemia which is at-least “small” in size, you will be contacted directly by our office personnel, shortly after the study report has been generated, to arrange for a clinical consultative office evaluation to discuss the significance of these results and the plan of care. Please note that additional invasive testing (i.e. diagnostic cardiac catheterization) may be recommended for such a finding.

Cardiac imaging (both nuclear and ultrasound) may disclose other anomalies (cardiac and non-cardiac) that technically may be interpreted as “not entirely normal” or “abnormal”. As noted, a detailed report will be sent to your physician or other requesting provider(s). Imaging procedures are not “perfect” and can be subject to mechanical or electronic imaging artifacts. You may call the Suncoast Heart Institute, PLLC, or your referring physician’s office to request a copy of your official procedure report. The report may involve the use medical jargon, which may be beyond an individual patient’s general medical knowledge and will require a detailed discussion for a satisfactory explanation and full understanding. We are always willing to spend additional time to discuss your testing results with you, in order to satisfy your concerns regarding your study results. If you feel that it is necessary to discuss the meaning of your testing results in more detail, please make an appointment to discuss the significance of your testing results with our staff physician. You may also wish to discuss the results further with your referring care provider (and he or she with you), during an upcoming office appointment.