Test Instructions

Are you having testing or treatment performed at our offices? To learn more about what you are going to have done, find the test and click on the link. Here you will learn how to prepare for your test, what medications you should not take before your test and what to expect.

Cardiac Nuclear Perfusion Stress Tests

‍Cardiac nuclear perfusion stress tests, sometimes called nuclear stress tests, come in two varieties: Exercise Nuclear Perfusion Stress Tests and Pharmacological Nuclear Perfusion Stress Tests. Both are ways of checking blood flow through the muscle (or walls) of your heart. A tracer dye is given to you through an IV inserted in your arm. A camera scans the tracer in the blood as it flows through your heart muscle.

• ‍Nuclear Stress Test Instructions
• Lexiscan Nuclear Medicine Instructions

What is Nuclear Perfusion Stress Testing?

A nuclear perfusion stress test checks to see how blood flows through your heart muscle. A tracer is injected through an IV and a camera scans the tracer in the blood as it flows through the heart muscle before and after you exercise on a treadmill. This is called an Exercise Nuclear Perfusion Stress test. If you are unable to exercise on a treadmill, a drug is used to substitute for exercise. This is called a Pharmacological Nuclear Perfusion Stress test.

During your nuclear stress test

You will first have scanning pictures taken while you rest.

To increase your heart rate will get your heart you will exercise on a treadmill for several minutes or if you are unable to exercise on a treadmill you will be given a medication.

When the exercise is over, you will have a second set of pictures taken.

After your test

Ask when you may eat and if you should take any medicine you were told to skip. Report any symptoms you feel like chest pain, shortness of breath and dizziness. The tracer leaves your body within hours.

If you have any concerns or questions, please feel free to contact our nuclear center.

What Do Normal Results from a Nuclear Stress Test Indicate?

Normal results from a nuclear stress test are typically a good sign of heart health. Here's what they generally suggest:

• Adequate Exercise Capacity: If you performed as well as or better than your peers—those of a similar age and gender—it indicates robust physical fitness levels.
• No Concerning Symptoms: You didn't experience symptoms such as chest pain or severe shortness of breath, which can be red flags during such tests.
• Stable Blood Pressure and Heart Rhythm: During the test, your blood pressure remained within a healthy range, and your ECG didn’t show alarming variations.
• Clear Imaging Results: The images obtained of your heart did not reveal any unexpected abnormalities in structure or movement.

Normal results imply that blood flow through your coronary arteries is likely unobstructed, suggesting that your heart is functioning well. However, it's crucial to remember that these results should be interpreted in the context of your personal health history and the reasons for undergoing the test in the first place. If there are other underlying health concerns, even normal test results require comprehensive evaluation by your healthcare provider.

What Are the Risks Associated with a Nuclear Stress Test?

Undergoing a nuclear stress test is generally safe, but like any medical procedure, it carries some risks. Here's a breakdown of what you might expect:

• Heart Rhythm Disturbances: It's possible to experience arrhythmias, which are irregular heartbeats, during the test.
• Angina Flare-ups: Some individuals might notice an increase in angina pain as a result of the stress induced by the test.
• Respiratory Issues: There could be instances of breathing difficulties or reactions similar to asthma symptoms.
• Blood Pressure Variability: The test may cause significant changes in blood pressure, potentially leading to episodes of high or low blood pressure.
• Dermatological Reactions: In rare cases, patients might develop skin rashes during or following the procedure.

Before the test commences, your healthcare provider will thoroughly review these risks with you, ensuring that you have a clear understanding of what to expect. This discussion is vital for making an informed decision about proceeding with the test.

Important Notices

48 HOURS NOTICE is required for all cancellations; otherwise you will be charged a cancellation fee and the cost of the isotopes ordered specifically for your test. In the event you fail to follow instructions, your test may be cancelled and fees applied.

Written orders/prescription for this test is required prior to performing all testing. If your insurance requires a referral, please obtain one from your primary care physician. All may be faxed to 571.323.3980 (Reston office) or 703.641.0383 (Fairfax office).

Test Locations:

1. 1830 Town Center Dr. Ste 405, Reston, VA 20190. Phone: 703-481-9191
2. 3023 Hamaker Ct., Ste 100, Fairfax, VA 22031. Phone: 703-641-9161
3. 224 D Cornwall St., Ste 306, Leesburg, VA 20176. Phone: 571-209-5490

What Additional Tests Might Be Needed Based on Nuclear Stress Test Results?

When your nuclear stress test results indicate potential issues, your doctor might recommend further diagnostic tests. Here are some common follow-up procedures:

1. Cardiac Catheterization:
   • This test provides a more detailed view of the coronary arteries.
   • It involves inserting a catheter into a blood vessel leading to the heart.
2. Echocardiogram:
   • Uses sound waves to produce images of your heart.
   • Evaluates heart function and structure in more detail.
3. CT Coronary Angiography:
   • Offers clear 3D images of the coronary arteries.
   • Utilizes CT technology to identify blockages or narrowing.

Each test provides unique insights, helping your doctor to tailor a treatment plan specific to your condition. Always consult with your healthcare provider to determine the best course of action for your specific needs.

How to Prevent False-Positive Results During a Nuclear Stress Test

False-positive results in nuclear stress tests can be concerning, but there are effective strategies to minimize their occurrence.

1. Precise Imaging Techniques: Utilizing advanced imaging technologies, such as SPECT (Single Photon Emission Computed Tomography) or PET (Positron Emission Tomography), can significantly enhance the accuracy of test results.
2. Patient Preparation: Proper preparation of the patient is crucial. This includes ensuring they fast or avoid caffeine and certain medications as advised by the healthcare provider, which can interfere with test accuracy.
3. Positioning Adjustments: Careful patient positioning during the test can also play a role. Adjusting the patient's position can help in distinguishing the heart's signals from those of other organs or structures.
4. Interpreting Results: Experienced technicians and physicians are essential for analyzing the test results. Their expertise helps distinguish between true cardiac issues and anomalies caused by external factors.
5. Follow-Up Tests: If any uncertainty remains, additional tests like echocardiograms or coronary angiograms can be conducted to verify initial findings.

Implementing these steps can significantly lower the likelihood of false-positive results, ensuring a more reliable diagnosis.

Echocardiogram

‍An echocardiogram is an imaging test that uses harmless sound waves. It shows how well your heart muscle is working, as well as how large your heart is. The sound waves are used like an ultrasound and are viewed on a monitor. Please click here for details

Stress Echocardiogram

‍A stress echocardiogram is like the echocardiogram described above except that the testing is done both before and after exercising in order to detect changes in the way your heart responds to exertion.

Stress Echo Instructions

What is an echocardiogram?

An echocardiogram, sometimes called an “echo,” is an imaging test that uses the echoes of sound waves that are bounced off your heart to create a moving picture of your moving heart, its muscles and valves. It shows how well your heart is working, as well as how large your heart is.

A small hand-held device called a transducer is used to transmit and receive the sound waves and echoes that take the pictures of your heart. Special equipment changes the echoes into images of your heart that are seen on a monitor. These images help the doctor evaluate your heart.

An echo is very safe and painless. In fact, echocardiograms are very similar to the imaging technique called sonograms or ultrasounds used with pregnant women to monitor the developing fetus while still in the womb.

Before your Echo

It is best to avoid eating within two hours prior to the test. Make sure you wear a two-piece outfit, you may need to undress from the waist up and put on a gown. Although the test itself takes less than 45 minutes, you should allow extra time to check in.

For this test, which is a non-stress echocardiogram, you may take your normal medications before the test.

During your Echo

Small electrodes are placed on your chest to monitor your heartbeat. A transducer coated with warm gel is moved firmly over your chest. This device creates the sound waves that make the images of your heart. At times, you may be asked to exhale and hold your breath for a few seconds. Air in your lungs can affect the images. The images of your heart are recorded on a CD so your doctor can review them.

Exercise Treadmill Stress Test

‍An exercise treadmill stress test is an electrocardiogram (EKG or ECG) conducted while walking on a treadmill to measure the heart’s response to the stress of physical activity.

What is an Exercise Treadmill Test?

It is an electrocardiogram (EKG or ECG) conducted while walking on a treadmill to measure the heart’s response to the stress of physical activity. Your blood pressure and heart rhythm are monitored during the test as well. The results aid in the detection of the disease which causes heart attacks, determination of cardiovascular fitness, and the safety of an exercise program. The test can show if there’s a lack of blood supply through the arteries that go to your heart.

Before your exercise treadmill test

Don’t eat, drink, smoke, or have any caffeine for 3 hours before your test. Make sure you wear a two-piece outfit and walking shoes, you may need to undress from the waist up and put on a gown.

Treadmill Instructions

What happens during the test?

You are hooked up to equipment to monitor your heart. You walk slowly in place on the treadmill. The treadmill will tilt so you feel like you are going up a small hill. It changes speeds to make you walk faster in order to increase your heart rate. The test is over when you reach your maximum heart rate or you feel you need to complete the test.

After slowing down for a few minutes, you will sit down and your heart rate and blood pressure will be monitored.

Report any symptoms

Be sure to tell the doctor if you feel any of the following during the test:

• Chest, arm, or jaw discomfort
• Severe shortness of breath
• Fatigue
• Dizziness
• Leg cramps or soreness

After your test

As soon as the test is over, you may eat and return to your normal routine.

Enhanced External Counter Pulsation/EECP

‍EECP is a non-surgical, mechanical procedure that can reduce the symptoms of angina pectoris, by increasing coronary blood flow in areas of the heart that lack blood flow.

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What Might Abnormal Results from a Nuclear Stress Test Mean?

If you've undergone a nuclear stress test and the results are abnormal, it may indicate several potential heart-related issues. Here's a breakdown of what these results could signify:

• Reduced Blood Flow: One common interpretation is reduced blood flow to areas of the heart, often due to narrowed or blocked arteries. This condition can limit the heart muscle's ability to receive adequate oxygen and nutrients, which is vital for its function.
• Heart Muscle Damage: Another possibility is that there might be scarring on the heart muscle. This could be a result of a past heart attack, where part of the heart tissue was damaged and subsequently scarred.

Potential Actions Following Abnormal Results

In response to these findings, healthcare professionals might recommend various interventions:

1. Angioplasty and Stent Placement: This procedure involves widening blocked arteries to restore blood flow, often supported by a stent to keep the artery open.
2. Medication Adjustments: Your heart medications might need to be changed or adjusted to better manage your heart condition and improve your heart's blood supply.
3. Coronary Angiography: This diagnostic test provides a detailed image of your heart's blood vessels, helping to identify more precisely any blockages or issues.
4. Heart Bypass Surgery: In some cases, bypass surgery may be required to create a new route around blocked arteries, ensuring the heart receives ample blood flow.

Understanding these potential outcomes can help prepare you for discussions with your doctor regarding the next steps in your heart health management. Always consult with a healthcare professional to determine the best course of action based on your specific condition.

How Do the Coronary Arteries Supply Blood to the Heart Muscle?

The coronary arteries play a crucial role in keeping the heart muscle nourished with a continuous supply of oxygen-rich blood. They consist of two main arteries: the right coronary artery and the left coronary artery.

• Right Coronary Artery (RCA): This artery is responsible for delivering blood to both the right side of the heart and some parts of the left side. It ensures that the right atrium and ventricle receive the necessary nutrients to function effectively.
• Left Coronary Artery (LCA): This splits into two significant branches—the left anterior descending (LAD) artery and the circumflex artery. The LAD supplies the front portion of the left side of the heart, while the circumflex covers the outer side and back of the left heart. Together, they ensure that the left ventricle, which pumps oxygenated blood to the rest of the body, receives ample blood supply.

In summary, the strategic division and distribution of blood by the coronary arteries guarantee that each part of the heart muscle remains well-oxygenated and efficiently operational.

What Are the Possible Follow-Up Procedures After Abnormal Test Results?

Receiving abnormal test results can be concerning, but understanding the next steps can help ease your mind. Here are potential follow-up procedures you might consider:

• Balloon Angioplasty with Stent: This minimally invasive procedure helps to open up clogged or narrowed blood vessels. A small balloon is used to expand the artery, and then a tiny metal mesh tube, or stent, is placed to keep it open.
• Adjustments in Medication: Your doctor may recommend changes to your prescription regimen. This might include switching doses or trying new medications aimed at better managing heart health.
• Coronary Angiogram: This diagnostic tool allows doctors to get a detailed view of the blood vessels in your heart, using X-ray imaging to locate blockages or narrowing.
• Coronary Artery Bypass Grafting (CABG): In some cases, bypass surgery is necessary to improve blood flow to the heart. This involves using a healthy artery or vein from another part of your body to redirect blood around a blocked one.

By discussing these options with your healthcare provider, you can determine the best course of action tailored to your specific condition and needs. Remember, taking these steps is about safeguarding your heart health and improving your quality of life.

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