Nuclear Cardiac Stress Testing: Thallium Scans

Occasionally, patients with dilated or restrictive cardiomyopathy may have a nuclear cardiac stress test to evaluate how well the heart muscle is being supplied with blood and how well the ventricles or chambers are working. This information is used to determine the best way to treat their symptoms.

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In a sense, nuclear testing is the opposite of X-rays. X-rays direct radiation into the body to create images; in a nuclear scan, the body emits the radiation from within to create the image. Trace amounts of thallium, a radioactive substance that emits gamma radiation, are injected into the bloodstream, usually through an IV in the arm. The thallium travels in the blood through the arteries and veins into the heart muscle. A special camera that detects gamma radiation is used to create images of the heart that are interpreted by nuclear medicine specialists.

Preparing for the test involves some dietary restrictions, including avoiding caffeine 24 hours before the scheduled test and wearing comfortable clothing and shoes. The test can last between two and four hours and begins with the insertion of an IV line for administering the thallium and the attaching of electrodes to the skin for monitoring the heartbeat with an electrocardiogram (ECG) machine. During the test, two sets of images are captured: one at rest and the other when the heart is stressed. Each set of images takes about 20 minutes to complete and requires the patient to lie as still as possible while the gamma camera rotates.

Thallium stress tests rely on either physical exercise using a treadmill or stationary bicycle or medication to stress the heart. Several different medications can be used to increase the workload to the heart; talk with your healthcare provider about which one is the best choice for you. The most common side effects from the medication are feeling flushed and feeling that your heart is beating faster and harder.