Sestamibi exercise stress test

Sestamibi exercise stress test (sestamibi stress test, stress perfusion scan, stress sestamibi): This diagnostic study uses a small amount of radioactive tracer injected into the body and a special camera to produce a computer image of the heart.

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Your doctor uses the sestamibi stress test to:

• Determine if there is adequate blood flow to your heart during increasing levels of activity.
• Evaluate the effectiveness of your cardiac treatment plan.
• Determine the likelihood of having coronary artery disease and the need for future testing.

To prepare:

• Do not eat or drink anything except water for four hours before the test. You will be allowed to eat once the second part of the test is complete.
  Do not drink or eat caffeine products for 24 hours before the test, including over-the-counter medication that contains caffeine such as Excedrin, Anacin, diet pills, and NoDoz.
• Ask your doctor what medications should be taken on the day of your test. Do not discontinue any medication without first talking with your doctor.
• If you use an inhaler for breathing, bring it to the test.
• If you are diabetic, ask your physician how to adjust your medications the day of your test. If you own a glucose monitor, bring it with you to check your blood sugar levels before and after the test. If you think your blood sugar is low, tell the lab personnel immediately.
• Wear comfortable clothes and soft-soled shoes suitable for walking. Women should wear a bra.

What to expect:

A nuclear medicine technologist will inject a small amount of thallium into a vein in your arm or hand. Thallium is a radioactive tracer that allows the physician to assess your heart function. Thallium is not a dye. You will be asked to lie very still under a camera with your arms over your head for about 15 to 20 minutes. The camera will record images that show the physician blood flow to each area of the heart muscle at rest.

Next you will go to the stress lab. A stress technician will clean 10 small areas of your chest and place small sticky electrode patches on these areas. Men may expect to have their chest partially shaved to help the electrodes stick. The electrodes are attached to an electrocardiograph (EKG) monitor, which charts your heart's electrical activity during the test.

The technician will perform a resting EKG, measure your resting heart rate, and take your blood pressure. An intravenous (IV) line will be started in the back of your hand. You will begin to exercise by walking on a treadmill or pedaling a stationary cycle. The degree of difficulty will gradually increase. You will be asked to exercise very hard until you are exhausted.

At regular intervals, the lab personnel will ask how you feel. Be sure to tell them if you feel chest, arm, or jaw pain or discomfort; shortness of breath; dizziness; lightheadedness; or any other unusual symptoms. It is normal for your heart rate, blood pressure, breathing rate, and perspiration to increase during the test. The lab personnel will watch for any symptoms or changes on the EKG monitor that suggest the test should be stopped. Your blood pressure and EKG recording will be taken during your test.

One minute before you stop exercising, a small amount of sestamibi (a different type of radioactive tracer) will be injected in the IV. Once the sestamibi is administered, the IV will be removed. You will also be asked to drink milk, which enhances the quality of the images.

After the test you will walk or pedal slowly for a couple of minutes to cool down. Your heart rate, blood pressure, and EKG will continue to be monitored until the levels begin returning to normal. About 30 minutes after you have finished exercising, you will be asked to again lie very still under the camera with your arms over your head for about 20 minutes. The camera will record images that show your physician how well blood flows through the coronary arteries to each area of the heart muscle during exercise.

You may be asked to return the next day or within a week for a third scan. Your physician will tell you if you need to come back after reviewing the results of the second scan. The appointment lasts about three to four hours, with the actual exercise time usually taking between seven and 12 minutes.