Test Overview
A cardiac perfusion scan measures the amount of blood in your heart
muscle at rest and during exercise. It is often done to find out what may be
causing chest pain. It may be done after a
heart attack to see if areas of the heart are not
getting enough blood or to find out how much heart muscle has been damaged from
the heart attack.
During the scan, a camera takes pictures of the heart after a
special test medicine (radioactive tracer) is given through an IV. The tracer travels through the blood and into the heart
muscle. As the tracer moves through the heart muscle, areas that have good
blood flow absorb the tracer. Areas that do not absorb tracer may not be
getting enough blood or may have been damaged by a heart attack.
Two sets of pictures may be made during a cardiac perfusion scan.
One set is taken while you are resting. Another set is taken after your heart
has been stressed, either by exercise or after you have been given a medicine.
The resting pictures are then compared with the stress images.
This test is also known by other names including myocardial perfusion scan, myocardial perfusion imaging, thallium scan, sestamibi cardiac scan, and nuclear stress test.
Why It Is Done
A cardiac perfusion scan is done to:
- Find the cause of unexplained chest pain or
chest pain brought on by exercise.
- Check for the location and
amount of damage caused by a heart attack.
- Identify
coronary artery disease (CAD).
- Help make
treatment decisions for a person with CAD.
- Check to see that the heart is getting enough blood after heart
surgery or angioplasty.
- Identify a
congenital heart defect and determine how serious it
is. These scans may also be done following surgery to correct a congenital
heart defect.
How To Prepare
Before a cardiac perfusion, tell your doctor if you:
- Are taking any medicines, including
erection-enhancing medicines (such as Cialis, Levitra, or Viagra). You may need
to take nitroglycerin during this test, which can cause a serious reaction if
you have taken an erection-enhancing medicine within the previous 48 hours. Ask
your doctor whether you need to stop taking any of your other medicines before
the test.
- Are allergic to any medicines or
anesthetics.
- Are or might be pregnant.
- Are
breast-feeding. Use formula and throw out your breast milk for 1 to 2 days
after the scan.
Do not eat or drink for at least 3 hours before a cardiac perfusion
scan. If you are having a stress scan, avoid alcohol, tobacco, caffeinated
beverages, and nonprescription medicines for at least 24 hours before the test.
Wear comfortable shoes and loose shorts or pants suitable for
exercise. Remove all jewelry before the test.
Talk to your doctor about any concerns you have regarding the need
for the test, its risks, how it will be done, or what the results may mean.
To help you understand the importance of this test, fill out the
medical test information form(What is a PDF document?).
How It Is Done
A cardiac perfusion scan is usually done in a hospital radiology or
nuclear medicine department, a doctor's office, or at an outpatient clinic. The
test is done by a doctor and technologist trained in
nuclear medicine.
Resting scan
For resting scans, in which you do not exercise, you will be
asked to remove your clothing above the waist, and you will be given a hospital
gown to wear. Electrodes might be attached to your chest to keep track of
your heartbeats.
You will have a very thin tube, called an IV, going into your arm or hand. A small amount of the
radioactive tracer will be put in the IV.
You will lie on your back on a table with a large camera
positioned above your chest. The camera records the tracer's signals as it
moves through your blood. The camera does not produce any radiation, so you are
not exposed to any additional radiation while the scan is being done.
You will be asked to remain very still during each scan, which
takes 5 to 10 minutes. The camera will move to take more pictures at different
angles. Several scans will be taken.
The entire test takes 30 to 40 minutes, after which you can
resume your normal activities.
Stress scan using medicine
The stress scan is done in two parts. In many hospitals, the
first images are taken while the person is at rest. Then a second set of images
is taken after the person is given a medicine such as adenosine,
which makes the heart respond like it would to exercise. Sometimes the stress scan is done first and the resting scan might be done the next day.
A stress test with
medicine is usually used when a person cannot exercise for some reason.
For this test, you will be asked to sit or lie on the examining
table and you will be given a routine electrocardiogram (EKG or ECG), which takes
about 5 to 10 minutes.
Then you will be given the medicine through your IV. You may get a
headache and feel dizzy, flushed, and nauseated from the medicine, but these
symptoms usually do not last long. Additional EKGs and blood pressure
measurements are often taken. After the medicine takes effect (about 4
minutes), a small amount of radioactive tracer is given through your IV.
You will wait about 30 to 60 minutes. You might be asked to eat or drink something. Then you will lie down
on a table for a set of scans. The camera records the tracer's signals as it
moves through your blood. The camera does not produce any radiation, so you are
not exposed to any more radiation while the scan is being done.
Sometimes more pictures are taken after you rest for 2 to 4
hours. Most people can resume their normal diet and activities after the final set of
scans.
Stress scan using exercise
For stress scans using exercise, your heart rate will be checked
with an
electrocardiogram (EKG or ECG). Because EKG electrodes need
to be attached to the chest to check the heart, men are usually bare-chested
and women usually wear a bra, gown, or loose shirt. For more information, see
the topic Electrocardiogram.
The exercise stress scan is done in two parts. First a set of
resting images is taken, then a set of stress images is taken immediately after
exercise. Sometimes the stress scan is done first and the resting scan might be done the next day.
In many hospitals, first resting pictures are taken using one type of
tracer. More pictures are taken using a different tracer after your heart has
been stressed by exercise.
In this stress test, you exercise on a treadmill or stationary
bike. Your heart rate will be checked during the test with standard
electrocardiography. Your blood pressure is checked using a blood pressure cuff
placed on your arm. For more information, see the topics
Exercise Electrocardiogram and
Electrocardiogram.
You will begin by walking or pedaling slowly and easily. Every
few minutes, the speed or incline of the treadmill or resistance of the bike
may be increased. You will exercise until you need to stop or until you reach a
suitable heart rate. At that point, you will be given a different tracer medicine through your IV.
You will probably continue to exercise for an additional 1 to 2 minutes to
circulate the radioactive tracer.
You will then lie down on a table for scanning. Each scan takes 5
to 10 minutes. The camera does not produce any radiation, so you are not
exposed to any additional radiation while the scan is being done.
Sometimes more pictures are taken after you rest for 30 minutes
to 4 hours. In some hospitals, you are given more radioactive tracer several hours after exercise and before the final image.
Most people can resume their normal diet and activities after the
final set of scans.
How It Feels
The cardiac scanning test itself is painless.
- You may feel a brief stinging or burning
sensation when the IV is inserted into your vein.
- You may be uncomfortable lying still for an extended period of
time on the table during the scans.
- If medicine to stress your
heart is used, you may have symptoms of mild nausea, headache, dizziness,
flushing, or chest pain. These symptoms only last a few
minutes.
- If you are asked to exercise, you may have chest pain,
breathlessness, lightheadedness, aching in your leg muscles, and fatigue.
Report these to the technician. If the symptoms are severe, the exercise part
of the test may be stopped.
- You will be asked to remain very still during each scan, which takes about 5 to 10 minutes. The camera will move to take more pictures at different angles. Several scans will be taken.
Risks
Cardiac perfusion scans are usually safe. There is always a slight
chance of damage to cells or tissue from radiation, including the low levels of
radiation used for this test. But the chance of damage from the radiation is
usually very low compared with the benefits of the test.
The risk of exercise depends on the condition of your heart and
your general level of health. The risks include:
- Fainting.
- Chest
pain.
- An irregular heartbeat.
- Heart attack.
There is a slight risk that death may result if a heart attack occurs during
the test.
After the test
Call 911 or other emergency
services immediately if you develop:
- Chest pain or pressure.
- Trouble breathing.
Results
Test results are usually available within 1
to 3 days.
A cardiac perfusion scan measures the amount of blood in your heart
muscle at rest and during exercise.
Results are:1
- Normal if radioactive tracer is evenly distributed throughout
your heart muscle.
- Abnormal if areas of abnormal tracer absorption are
present. This means some areas of heart muscle are not getting enough blood
(ischemia). This may mean that the heart has been damaged or that coronary artery
disease is present.
What Affects the Test
Reasons you may not be able to have the test or why the results may
not be helpful include:
- A recent, serious
heart attack.
- Inflammation of the heart,
such as
myocarditis or
sarcoidosis.
- Bruising of the heart muscle
(cardiac contusion).
- Weakening of the heart
muscle.
- Stiffening of the heart muscle (myocardial
fibrosis).
- A severely narrowed heart valve.
- Implanted
cardiac devices, such as a
pacemaker.
- A condition that makes it difficult to exercise, such as lung
disease,
arthritis, or a neuromuscular
problem.
- Some medicines, such as dipyridamole (Persantine) and
pentoxifylline (Trental).
- Severe
electrolyte imbalances (especially calcium, potassium,
sodium, or magnesium).
- Pregnancy or breast-feeding (except in an
emergency).
Test results may be difficult to interpret in scans done on women
with large breasts.
Other Places To Get Help
Organizations
|
American Heart Association (AHA)
|
| 7272 Greenville Avenue |
| Dallas, TX 75231 |
| Phone: |
1-800-AHA-USA1 (1-800-242-8721) |
| Web Address: |
www.heart.org |
| |
|
Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.
|
|
|
National Heart, Lung, and Blood Institute
(NHLBI)
|
| P.O. Box 30105 |
| Bethesda, MD 20824-0105 |
| Phone: |
(301) 592-8573 |
| Fax: |
(240) 629-3246 |
| TDD: |
(240) 629-3255 |
| Email: |
nhlbiinfo@nhlbi.nih.gov |
| Web Address: |
www.nhlbi.nih.gov |
| |
|
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
and treating:
- Diseases affecting the heart and circulation, such as heart
attacks, high cholesterol, high blood pressure, peripheral artery disease, and
heart problems present at birth (congenital heart diseases).
- Diseases that affect the lungs, such as asthma, chronic
obstructive pulmonary disease (COPD), emphysema, sleep apnea, and
pneumonia.
- Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.
|
|
References
Citations
-
Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis:
Saunders.
Other Works Consulted
- Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis:
Saunders.
- Fischbach FT, Dunning MB III, eds. (2009).
Manual of Laboratory and Diagnostic Tests, 8th ed.
Philadelphia: Lippincott Williams and Wilkins.
- Klocke FJ, et al. (2003). ACC/AHA/ASNC guidelines for
the clinical use of cardiac radionuclide imaging—Executive summary. A report of
the American College of Cardiology/American Heart Association Task Force on
Practice Guidelines. Circulation, 108(11): 1404–1418.
Available online:
http://circ.ahajournals.org/content/vol108/issue11/index.shtml.
- Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.
Credits
|
By
|
Healthwise Staff |
|
Primary Medical Reviewer
|
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology |
|
Specialist Medical Reviewer
|
George Philippides, MD - Cardiology |
|
Last Revised
|
December 9, 2011 |