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Specialty Clinic 616 North Eighth Street Osage, IA 50461 www.mcrhc.com NUCLEAR MEDICINE CARDIOLITE STRESS TEST GXT Treadmill and Lexiscan Your provider has requested that you have a Cardiolite nuclear medication test examination on ___________________(date) at Mitchell County Regional Health Center. Please check in at_________a.m. at the Hospital Registration desk, located near the main entrance at the front of the building. Please allow at least four hours for completion of the entire test. IF YOU ARE UNABLE TO KEEP YOUR NUC MED APPOINTMENT, PLEASE CALL 641-732-6106 DURING BUSINESS HOURS AND 641-732-6000 AFTER BUSINESS HOURS TO CANCEL. PLEASE INDICATE THIS IS A NUCLEAR MED TEST. IF STUDY IS NOT CANCELED BY 3:00 A.M. DAY OF STUDY, CHARGES DO OCCUR. What is it? A Cardiolite stress test is a way to determine if your heart muscle is getting enough blood supply. This test can help your doctor determine if you have coronary artery disease, a condition where blood vessels that give oxygen rich blood to your heart muscle become narrowed or blocked. It can show areas of the heart muscle that do not get enough blood supply and areas that have been damaged after a heart attack. Cardiolite is a nuclear radioactive substance that is injected into your vein. It involves only a small amount of radiation and poses no greater radiation exposure risk than routine X-ray exposure. The tracer concentrates in those parts of the heart that have the best blood flow. It emits signals that can be detected by a special type of camera. How is the Cardiolite stress test done? There are two types of Cardiolite stress tests. One is the exercise stress test and the other is called the medication stress test. Both tests are done in two phases and evaluate blood flow to the heart during rest and during stress. In the exercise stress test, you will exercise by walking on a treadmill with the exercise being the “stress” for the heart. In the medication stress test, you are given a medication through your vein that makes your heart mimic exercise. The medication test will be done if you are unable to exercise at a moderate to high level on the treadmill. It is done at rest lying on a cart. If you have a pacemaker, a defibrillator, or a Specialty Clinic 616 North Eighth Street Osage, IA 50461 www.mcrhc.com certain heart pattern on your ECG, the medication test will be done while lying on a cart or sitting in a chair. How do I prepare for the test? Do not eat or drink anything except sips of water for 6 hours before the test Do not smoke or use chewing tobacco for 12 hours before the test Do not eat or drink anything with caffeine for 24 hours before the test. This would include: No coffee or tea, brewed, instant, iced, or decaffeinated No cappuccino No colas or other soft drinks including those labeled decaffeinated or “caffeine-free” No chocolates, including candies, frosting, cookies, pies, cocoa, and chocolate milk. Do not use any medicines (over the counter or prescribed) that contain caffeine for 24 hours. This may include Anacin, Excedrin, Darvon, Fiorinal, Cafergot, Ergotamine, Midol, No-Doz, or Vivarin Do not use theophylline or medication containing theophylline (Quibron, SloPhyllin, or Theo-Dur) for 48 hours before the test unless your doctor says it is ok. Do not take Persantine (dipyridamole) or Aggrenox for 48 hours before the test Do not take certain medications for heart or blood pressure for 24 hours before your test unless directed by your physician. This would include Toprol (metoprolol, lopressor), atenolol (tenormin), betapace (sotalol), coreg (carvedilol), inderal (propranolol) bystolic (nebivolol), or corgard (nadolol). These may interfere with the accuracy and effectiveness of the exam. If you take medications for blood pressure other than those listed, you may be advised to take them with a sip of water the morning of the test. Bring a list of all medicines you are taking. Bring your morning medications with you. You will be allowed to take them after the exercise or medication portion of the test. If you are diabetic and are taking insulin, ask your doctor about changing the amount of insulin you would take or if you should wait to take it after the test. Wear comfortable clothes and walking shoes. For women, slacks or shorts are preferred as you may be asked to put on a hospital gown. The day of test After you have registered, the nurse will come and get you and take you to the stress lab. A brief history will be obtained and the procedure will be explained to you. You will be asked to sign a consent form for the test. Please read the form carefully and make sure your questions are answered. Specialty Clinic 616 North Eighth Street Osage, IA 50461 www.mcrhc.com An IV (intravenous) catheter will be placed in your hand or arm. The medication will be injected into the IV catheter by the nuclear medicine technician. There are no side effects from this substance. You will have a waiting period of approximately 60 minutes to allow time for the medication to circulate to your heart. You may wait in the registration area during this time. After your wait time, the rest images will be obtained. After the rest images are completed, you will return to the stress test room for the stress portion of the test. Small pads called electrodes will be placed on your chest so that your heart rate and rhythm can be monitored during the test. We may need to shave excess hair from the sites where the electrodes will be placed. Your blood pressure may be checked with you lying, sitting, and standing before the test. The nurse will also monitor your blood pressure during the test. Exercise (GXT Treadmill) Stress Test If you’re doctor has ordered an exercise stress test, you will walk on the treadmill until your heart rate reaches a certain level. The intensity of exercise is gradually increased. It is important to exercise as long as you are able to increase the effectiveness of the test. Please inform the doctor if you have symptoms of chest discomfort, shortness of breath, dizziness or feeling faint, or leg cramps. The exercise can be adjusted or stopped if you feel like you cannot go on. If you are not able to exercise to an intensity that will increase your heart rate to the desired level, the doctor may stop the exercise test and change to a medication stress test. Cardiolite is again injected into the IV catheter once you have reached your target heart rate. It is important that you continue to walk for an additional minute after the Cardiolite is injected. Once injected it is carried to the heart by the blood. After exercise you will be seated and your heart rate/rhythm and blood pressure will be monitored for approximately 8-10 minutes after you are finished with the exercise. Medication (LEXISCAN) Stress Test For the medication stress test, an injection of medication is given into your IV. This medicine dilates the blood vessels and simulates the effects of exercise. This medication can cause certain symptoms such as a flushed feeling, chest pressure/pain, shortness of breath, lightheadedness, abdominal pain, nausea, headache, or palpitations. These feelings are perfectly normal but you should tell the doctor or nurse what you are feeling. Because the medication is very short acting these symptoms should disappear within several minutes after the injection is completed. Your second injection of Cardiolite is given immediately after the injection of the medication. After the injection is complete you may rest in a chair or on the cart for 8-10 minutes while your heart and blood pressure are monitored. Specialty Clinic 616 North Eighth Street Osage, IA 50461 www.mcrhc.com After the stress test After the recovery period, a light snack can be obtained in the cafeteria while waiting for your next images. Additional images, which will be taken ½ to 1 hour later, will show which areas of the heart the tracer has reached. Once these images are completed you will be free to go. You may resume your usual diet, medications, and activities after the test. The tracer leaves your body quickly through your urine. Drinking plenty of water will help flush the tracer out of your body. If you experience any problems following your procedure please notify your physician or if after hours you may call the hospital and speak with a nurse. Results A cardiologist will review and interpret the pictures obtained through imaging and the information obtained from the ECG. Your personal physician will be able to review the results with you at your follow up appointment. Insurance Information 1. If your insurance requires a pre-authorization, it will be obtained by your ordering provider prior to the test being scheduled. Medicare does not require a preauthorization. Pre-authorization does not insure that this test is a covered benefit. 2. You are responsible for contacting your insurance company to make sure this test is a covered benefit and to answer any other questions you may have in regards to your individual insurance coverage. 3. Please bring your current insurance card to your appointment