Download PROGRESSIVE MEDICAL CLINICS, LLP Dobutamine Stress Test

PROGRESSIVE MEDICAL CLINICS, LLP
Dobutamine Stress Test Information and Instructions
IMPORTANT TESTING INSTRUCTIONS
DO NOT EAT, DRINK OR SMOKE SIX HOURS BEFORE THE TEST.
Allow approximately six hours for the test, which is divided into two sessions. The first session will take about 90 minutes. You will
be allowed to leave the hospital after completion of the first session for three to hour hours. The second session will take about 45
minutes. You may be asked to return for a third session the next day.
Bring a list of medication you routinely take.
If you are currently taking any heart of blood pressure medication, check with you physician. He/she may ask you to stop certain
medications for a day or two before the test.
If you are a diabetic taking insulin, notify your physician for possible dosage adjustments.
Before the test, you will be given an explanation of the test and you will be asked to sign a consent form. Feel free to ask any
questions.
WHAT IS A DOBUTAMINE THALLIUM STRESS TEST?
A Dobutamine Thallium stress test helps diagnose coronary artery disease or identifies areas of the heart that lack an adequate blood
supply due to narrowed or blocked coronary arteries. Coronary arteries are located on the outside of the heart and bring oxygen-rich
blood to the heart muscle. Your physician has determined that you are unable to exercise adequately on the treadmill or stationary
bicycle. Dobutamine is a medication that gradually increases your heart rate similar to what happens during exercise. Dobutamine and
thallium are infused (given slowly) through a vein in the arm. Thallium (a radioactive substance known as a tracer) travels in the
blood stream to the heart where it is picked up the tracer very slowly or not at all. The tracer emits a small amount of radio-activity
that will be detected by a special scanning camera shortly after the Dobutamine is stopped. If an area of the heart muscle receives less
blood supply than the rest of the heart because of narrowed or blocked coronary arteries, the scan will show fewer tracers in the area
of the heart muscle. A second set of scans will be taken three to four hours later. You may leave the hospital in between imaging
sessions to eat. Please avoid all foods, beverages and products containing caffeine and nicotine (coffee, tea, cola, soft drinks
containing caffeine, chocolate, cigarettes, chew and pipe tobacco) until completion of the test. The second session and possible third
sessions take about 45 minutes each. The scan help the physician determine areas of the heart muscle that may not be receiving
enough blood supply or areas that are permanently damaged from a heart attack. A cardiologist will read the test within 24 hours and
any serious concerns will be reported to your physician immediately. Test results will be mailed to your physician.
WHAT ARE THE SIDE EFFECTS OF DOBUTAMINE?
Side effects may occur during Dobutamine infusion, but they are usually mild and last only for a few minutes. They may include chest
discomfort, headache, palpitations, nausea or shortness of breath. These symptoms are relieved quickly when the Dobutamine is
stopped.
WHAT HAPPENS DURING THE TEST?
Several electrodes (adhesive patches) will be placed on your chest to record heart activity during the test and will be continuously
monitored by experienced cardiac nurses. While lying on a bed, Dobutamine is given through a vein in your arm. You will be
instructed to report any symptoms such as chest discomfort, headache, shortness of breath, palpitations or nausea. The dose is
increased every three minutes to gradually increase your heart rate. This makes your heart bet faster and harder similar to what
happens when you exercise. The cardiologist will increase the medication to achieve a target heart rate that is based upon your age.
Once the target heart rate is reached (usually within nine to 12 minutes while your blood pressure and electrocardiogram are
monitored, you will be taken to the Radiology Department where a special camera will take images of your heart for about 30 minutes
while you are lying down. You will be given instructions on what time you need to return to the Radiology Department for the second
and possible third imaging sessions which take about 45 minutes.
IS THE DOBUTAMINE THALLIUM STRESS TEST SAFE?
The radiation exposure from the Thallium during the test is small (less than a chest x-ray), and the doses used are safe. The scanning
camera detects the Thallium; it dose not take x-rays. However, if you are pregnant, suspect you may be or are a nursing mother,
discuss the test with your doctor. The test is also safe, but a small amount of risk exists with any test that stresses the heart. Possible
rare complications include abnormal heart rhythm, low blood pressure or a heart attack. Experienced personnel are available to handle
any emergency.
Memorial-Hermann Southeast Medical Plaza II
11920 Astoria Blvd., Suite 300
Houston, Texas 77089
Phone: (281) 481-8878 Fax: (281) 481-9020
www.progmd.com
PROGRESSIVE MEDICAL CLINIC, LLP
INFORMED CONSENT FOR DOBUTAMINE STRESS TESTING
In order to determine an appropriate plan of medical management, I hereby consent to
voluntarily engage in an exercise test to determine the state of my heart condition and
circulation. The information thus obtained will help my physician in advising me as to
the activities in which I may engage.
If not done prior to test day, I will have an interview with a physician. I will also be
examined by a physician to determine if I have any condition which would indicate that I
should not engage in this test.
The test, which I will undergo, Dobutamine-Myoview imaging, is a non-invasive
physiologic technique for assessing myocardial perfusion/blood flow and the presence
and extent of coronary artery disease.
I will receive an infusion of the drug Dobutamine. The administration of this drug
increases the contractility of the heart muscle.
There exists the possibility of certain changes occurring during the test. They may
include headache, nausea, palpitations, ventricular tachycardia, EKG changes, chest pain
and very rare instance of heart attack. Every effort will be made to minimize possible side
affects by the physician’s preliminary exam and by observations during the testing.
Emergency equipment and trained personnel are available to deal with unusual situations,
which may arise.
The information, which is obtained, will be treated as privileged and confidential, and
will not be released or revealed to any person without my express written consent. The
information obtained, however, may be used for statistical or scientific purposes with my
right of privacy retained.
I have read the foregoing; I understand it and any questions, which may have occurred to
me, have been answered to my satisfaction.
Print: ______________________________
Sign: ______________________________
Date: ______________________________
Witness: ______________________________
MEMORIAL SOUTHEAST PROFESSIONAL BUILDING II
11920 ASTORIA BLVD., SUITE 300 HOUSTON, TEXAS 77089
Tel: (281) 481-8878 Fax: (281) 481-9020
www.progmd.com
DO NOT TAKE MEDICATION LIST
Do not take any of the following medications 48 hours prior to your study:
Aerolate (all forms)
Aggrenox
Aminophylline
Asbron G (tabs, elixir)
Brankodyl
Caffergot (contains caffeine)
Cialis
Choledyl (all forms)
Constant-T
Dilor (all forms)
Dipyridamole
Elixophyllin
Fioricet(contains caffeine)
Fiorinal (contains caffeine)
Levitra
Lufyllin
Marax
Norgesic
Norgesic Forte
Pentoxyflline
Persantine
Primatene Tablets
Quadrinal
Quibran-SR
Respbid
Slo-bid
Somophyllin
Sustaire
T-phyl
Tedral SA
Theo-24
Theo bid Duracap & Jr.
Theochron
Theoclear LA
Theo-Dur (all forms)
Theo-Dur Sprinkle
Theolair
Theo-Organidin
Theophlline
Theospan SR
Theo. Sav.
Theo Vent
TheoX
Trental
Respid
Uniphyl
Viagra
Xanthine
Do not take any of the following medications 24 hours prior to your study:
Anacin
Aminophylline
Cafergot
Darvon Compound
Dipridamole
Esgic
Excedrin
Fioricet
Fiorinol
No Doz
No Inhalers
Norgesic
Norgesic Forte
Pain medication
Persantine
Synalgos
Wigraine
Do not take any of the following medications 12 hours prior to your study:
* Calcium Channel Blocker:
Ditiazem
Tiazac
Verapamil
* Digoxin
*No Beta-Blocker:
Atenolol (Tenormin)
Beta Pacem (Steolol)
Betoptie (Bexaxolol)
Blocadren (Timolol)
Breviloc
Cartrol
Coreg (Carvedilol)
Corgard
Inderal
Inderal LA (Propranolol)
Levatol
Lopressor (Metoprolol)
Normadyne (Labetolol)
Ziac (Bisoprolol)
Zebeta
Do not take any of the following diabetic medications on the day of the test:
Amaryl
Actos
Insulin
Glucophage
Glucotrol
Glucovance
Glyburide
Metformin
Starlix
FOOD AND DRINKS
*** Discontinue 24 Hours Prior to Exam ***
*** NO CAFFEINE***
Coffee
Hot Chocolate/Any Chocolate
Dr. Pepper
Decaffeinated Coffee
Colas
Mr. Pibb
Tea
“Caffeine Free” Colas
Mountain Dew
DO NOT smoke or use any tobacco products after midnight the night before the test!!!
BRING ALL OF YOUR MEDICATION BOTTLES
TO YOUR APPOINTMENT!!!!!