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C O N S E L L E R I A D E S A N I T A T Gammagraphy of the myocardial perfusion (Myocardial SPECT, stress test with isotopes, isotope ergometry) 1. Identification and description of the procedure The myocardial perfusion gammagraphy is an imaging diagnostic method hat permits the study of the blood flow in the myocardium and the integrity of the cells after the intravenous administration of a radioactive tracer (Talium-201, isonitriles or tetrophosmins marked with Technecium-99m). The state of the myocardial perfusion can be studied in resting conditions, during a controlled physical effort or after the administration of different pharmaceuticals. The habitual exploration consists of a stress test with rolling tape or ergometric bicycle, administering the tracer at the moment of maximum effort, obtaining posterior images that reflect the state of the myocardial perfusion at the time of most effort. If the result is not absolutely normal, another exploration will be performed afterwards while resting, being able to be completed on the same or different days, depending on the type of tracer and protocol used. If the patient presents physical impossibility to perform the stress test, the exploration will be performed after the administration of a pharmaceutical equivalent to the effect of the effort. The studies are usually obtained through tomography technique (SPECT), meaning, making multiple images around the heart, always when possible, with a synchronized electrocardiogram, so as to be able to identify the start of each heart beat. These images are then submitted to a careful computer process, by which the existence of perfusion defects is studied and its localization in any myocardial segment, its severity and extension is quantified, it is compared to the stress test and rest period of the same patient, you can also obtain, if the synchronized study has been performed, the evaluation of the ventricular function, that is to say, the contraction capacity of the heart, both globally as well as regionally and both while resting as well as after the effort. It may be necessary to withdraw some of the patientÂ’s normal medications one or various days before the exploration, as well as only having a light meal between the injection of the tracer and the image collection to favour the elimination of the tracer part and so that the image quality is optimal. Previously, upon carrying out the exploration, the corresponding Nuclear Medicine Service personnel will inform you of the procedure and will answer your questions regarding it. 2. Purpose of the procedure and benefits that are expected to be achieved Diagnosis of the coronary illness, acute or chronic, determining he existence, localization, extension and severity of the myocardial ischemia and myocardial infarction. Prognostic evaluation of the possible evolution of the coronary disease. SPECIALITY IN NUCLEAR MEDICINE Evaluation of the existence of viable myocardia, that is to say with possibility of recuperation if an operation is performed on it by angioplasty or by-pass. Evaluation of the results and posterior evaluation of the treatments both medicational as well as different operation on the heart. It is the only procedure to be able to directly study the myocardial perfusion during physical effort, obtaining rigorous and detailed information regarding the myocardial blood flow as well as the cardiac functionality, as well as being a simple technique to perform for the patient, that it has low radiation dose very inferior to other radiological techniques. 3. Reasonable alternatives to this procedure Through a cardiac PET we can also directly study the myocardial perfusion but it is performed after the pharmaceutical stimulation as well as the myocardial viability, even though currently it is a scarcely available exploration. Other explorations such as the echocardiography or MRI allow an indirect study of the status of the myocardial perfusion through the alteration of the heart contractions; generally after pharmaceutical stimulation, currently other more direct studies are still under the initial phases. The contrast coronariography studies the anatomic lesions of the heart while the perfusion gammagraphy allows us to get to know the real functional significance of these lesions, so they are considered complementary methods in the evaluation of coronary patients. However, the contrast coronariography is performed through cardiac catheters that require hospitalization and the administration or radioactive contrast that can represent a severe risk in determined patients. Gammagraphy of the myocardial perfusion (Myocardial SPECT, stress test with isotopes, isotope ergometry) 4. Foreseeable consequences of its performance To contribute to the diagnosis and adequate treatment of the patient as well to the posterior follow-ups. To contribute to the prognostic evaluation of the cardiac patient, as well as the correct recomendation of a revascularization operation. 5. Foreseeable consequences of its non performance To contribute to the diagnosis and treatment of the patient. Incorrect diagnosis or prognosis. Inadequate recommendation for a revascularization operation. 6. Frequent risks Not described. 7. Infrequent risks. The scarce risks that a physical effort test can carry or a pharmaceutical under medical control. 8. Risks depending on the patient's clinical situation The exploration is not advised for pregnant women, even though in exceptional circumstances the risk/benefit will be evaluated. In case of performing the exploration on a woman during lactation, she must interrupt it during a short time period. During the day of the exploration close contact with small children and pregnant women must be avoided. 9. Declaration of consent Mr./Mrs./Miss. aged , with home address at , National Identity No. Mr./Mrs./Miss. and SIP number aged , with home address at acting in the capacity of (the patient's legal representative, relative or close , with National Identity No. friend) HEREBY DECLARE: That the Doctor situation to perform In has explained to me that it is advisable/necessary in my on ,2 With National Identity Card No Signed: Dr. With National Identity Card No Associate number 10. Revocation of the consent I hereby revoke the consent granted on the date of to carry on with the treatment that I hereby terminate on this date. In Signed: The Doctor Associate number: on ,2 Signed: The patient ,2 and I do not wish SPECIALITY IN NUCLEAR MEDICINE Signed: Mr./Mrs./Miss.