Nuclear Stress Testing

This is a non-invasive test which uses a small radioactive tracer to obtain images of the heart.  Multiple views of the heart are obtained to ensure that all areas of the heart muscle are visualized.  A nuclear gamma camera and treadmill or medicated stress test allows the Nuclear Technologist and Physician to see the blood flow to the heart muscle.  With this technology the physician is able to measure the size of the heart, blood flow to the heart muscle and calculate the function of the heart.
There is prep for this exam; see how to prepare for the test below, and it takes approximately 3 hours.  10 electrodes are placed on the chest to obtain the ECG, an IV will be started and blood pressures will be taken. Then the Nuclear Technologist will use the gamma camera to obtain the images needed for a diagnosis.  You must be able to lay with your left arm above your head and not be claustrophobic for two sets of images.

Indications include the following:

  • Evaluation of chest discomfort, especially typical chest discomfort or pain.
  • Evaluation of known coronary artery disease
  • Evaluation of patients, with cardiac risk factors prior to surgery.
  • Evaluation of the results of surgical revascularization, angioplasty, thrombolytic therapy or medical management.
  • Evaluation of dysrhythmia and re-evaluation to determine the efficiency of therapeutic management.
  • Determination of functional capacity of a patient following a myocardial infarction or cardiac surgery.
  • Pre-rehabilitation and post-rehabilitation evaluation.                
  • Determination of exercise capacity and cardiopulmonary responses in health individuals who require exercise prescriptions or occupational activity guidelines.  
  • May be used to optimize medical therapy with certain classes of drugs, such as antianginal agents, antihypertensive agents, chronic heart failure agents, and antidysrhythmic agents.
Middletown Cardiovascular Technologist is board certified by the Nuclear Medicine Technologist Certification Board and has more than 23 years of experience.  Middletown Cardiovascular labs are accredited by the Intersocietal Commission for the accreditation of Nuclear Laboratories (ICANL) and our equipment is state-of-the-art.
Stress Test
After a baseline set of images you will proceed to the stress test. For the stress test, you will be attached to an ECG and blood pressure machine which will be monitored while your stress test is being performed, whether it is the treadmill or medication. You will then receive a second radioactive tracer and the stress images will be done about an hour after your stress test. This will allows the physician to evaluate the blood flow to the heart before and after stress.  When a heart muscle is getting a good supply of blood through its coronary arteries the heart becomes more vigorous with the activity.  However, an indication of a blocked or narrowed coronary artery can be detected by a decrease in blood flow to wall segments fed by that artery.  The doctor evaluates all segments of the heart to evaluate if a patient has Coronary Artery Disease.  It is important to understand that this is a non-invasive test and does not actually image the arteries themselves.
For patients who are unable to exercise on a treadmill, there are medications that can be used (such as Lexiscan or Adenosine) to simulate exercise by dilating the heart vessels for a few minutes.  When the medication is stopped, the vessel dilation will stop, similar to stopping exercise.
How to prepare for the test:
Do not eat or drink three (3) hours prior to the test except water.  This will help prevent the possibility of nausea with exercise.
Do not eat or drink anything with caffeine or decaffeinated products in it for at least 12 hours prior to testing.
If you are currently taking medications, be sure to check your instructions to see if your doctor wants you to take them or not, on the day of the test.  If you are still not sure, contact our office, a nurse will be happy to assist you.
What to wear?  Comfortable, short sleeve shirt with no metal buttons or decorations, no dresses or one piece outfits, and good sturdy gym shoes.  No sandals, flip flops, clogs or high heels, if your doctor ordered an Exercise Nuclear Test. (Shoes do not matter with a Medicated Nuclear Test).

MCA's Nuclear Lab is an accredited Lab through the Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories (ICANL) since December 2008.  Reaccreditation occurs every three years upon the submission of case studies, meeting minutes, reports meeting strick criteria and a review of our protocols and continuing education of our registered Technologists.  For more information about the ICANL you can visit their website: