• See Also
  1. Exercise Stress Test
  2. Stress Imaging
  3. Pharmacologic Stress Test
  4. Stress Echocardiogram
  5. Stress Myocardial Perfusion Imaging
  • Definitions
  1. Myocardial Perfusion Imaging with Adenosine
    1. Pharmacologic Stress Testing in which Adenosine is used to stimulate increased cardiac workload
  • Approach
  1. Hold nitrates (Nitroglycerin) on day of the test
  2. Hold methylzanthines 24 hours before test
    1. Theodur
    2. Aminophylline
    3. Dipyridamole
  • Preparations
  1. Adenosine or
  2. Regadenoson (Lexiscan)
    1. Longer half life than Adenosine
    2. Can be adminstered as bolus instead of continuous infusion
  • Advantages
  1. Short duration of Adenosine action (<3 seconds)
  2. Vasodilator increases coronary flow 5x
  3. More sensitive than Dobutamine (but less specific)
  4. ST Depression specific for serious disease
    1. Left main Coronary Artery Disease
    2. Three-vessel Coronary Artery Disease
  • Indications
  1. Left Bundle Branch Block
  2. Paced Rhythm
  3. WPW Syndrome
  • Contraindications
  1. Hypotension with systolic Blood Pressure <90 mmHg
  2. Significant atrial Arrhythmia without a functioning Pacemaker
    1. Sinus node disease
    2. Mobitz 2 or Third Degree AV Block
  3. Active Wheezing in bronchospastic disease
    1. Moderate to Severe Asthma
    2. Severe Chronic Obstructive Pulmonary Disease (COPD)
  4. Concurrent medication use
    1. Dipyridamole
    2. Aggrenox
    3. Theophylline
    4. Caffeine prior to test (e.g. Coffee, Chocolate)
  • References
  1. Cayley (2024) Am Fam Physician 110(6): 577-84 [PubMed]