Preparing for Your Nuclear Stress Test

What is a Nuclear Stress Test?

A nuclear stress test is a safe, painless imaging procedure that I use to evaluate how well your heart works during physical activity and at rest. This test combines exercise (or medication that mimics exercise) with nuclear imaging to create detailed pictures of blood flow to your heart muscle.

During the test, a small amount of radioactive tracer is injected into your bloodstream. This tracer is absorbed by healthy heart muscle, allowing us to see areas that may not be receiving adequate blood flow. The "stress" portion involves either walking on a treadmill or receiving medication that increases your heart rate.

Why Do You Need This Test?

I have ordered this test to:

  • Evaluate chest pain or shortness of breath

  • Assess your risk for heart disease

  • Monitor existing heart conditions

  • Determine if treatments are working effectively

  • Evaluate your heart function before surgery

  • Check for blocked or narrowed coronary arteries

Before Your Test

24-48 Hours Before Your Appointment

Stop These Medications (unless I have instructed otherwise):

  • Caffeine-containing medications

  • Beta-blockers (metoprolol, atenolol, propranolol)

  • Calcium channel blockers (amlodipine, diltiazem, nifedipine)

  • Nitrates (nitroglycerin, isosorbide)

Continue Taking all other prescribed medications unless I have specifically told you otherwise.

The Day Before Your Test

Avoid All Caffeine including:

  • Coffee (regular and decaf)

  • Tea (including green and herbal teas)

  • Chocolate and cocoa

  • Soft drinks and energy drinks

  • Pain relievers containing caffeine

Prepare Comfortable Clothing:

  • Wear or bring comfortable walking shoes with good support

  • Dress in loose, comfortable clothing

  • Men should wear a shirt that opens in the front or bring a hospital gown

  • Women should wear a comfortable bra and bring a robe or shirt that opens in the front

Day of Your Test

Fasting Requirements:

  • Do not eat or drink anything except water for 4 hours before your test

  • Take your morning medications with small sips of water (unless I have told you otherwise)

  • If you have diabetes, we will have discussed meal timing and medication adjustments beforehand

What to Bring:

  • Insurance cards and photo identification

  • List of current medications

  • Comfortable walking shoes

  • Reading material (the test takes 3-4 hours total)

What to Expect During Your Test

Part 1: Rest Images (30-45 minutes)

  1. IV Placement: A nurse will place a small IV line in your arm

  2. Tracer Injection: A tiny amount of radioactive tracer will be injected through your IV

  3. Waiting Period: You'll wait 15-60 minutes for the tracer to circulate through your body

  4. First Images: You'll lie on a table while a special camera takes pictures of your heart (15-20 minutes)

Part 2: Stress Portion (30-45 minutes)

Treadmill Exercise:

  • You'll walk on a treadmill that gradually increases in speed and incline

  • My team will continuously monitor your heart rate, blood pressure, and heart rhythm

  • Tell us immediately if you experience chest pain, shortness of breath, dizziness, or unusual fatigue

  • The exercise portion typically lasts 6-12 minutes

Medication Alternative (if you cannot exercise):

  • If you cannot walk on a treadmill, you'll receive medication through your IV

  • This medication increases your heart rate and blood flow, simulating exercise

  • You may feel warm, flushed, short of breath, or have mild chest discomfort - this is normal

Part 3: Stress Images (30-45 minutes)

  1. Second Tracer Injection: At peak exercise or medication effect, another tracer injection is given

  2. Brief Recovery: You'll cool down and be monitored for a few minutes

  3. Second Set of Images: After a short waiting period, we'll take another set of heart pictures

After Your Test

Immediate Recovery:

  • You can resume normal activities immediately

  • Drink plenty of fluids to help flush the radioactive tracer from your system

  • The tracer will naturally leave your body through urine within 24-48 hours

Resuming Medications:

  • You may resume all medications that were stopped for the test

  • Follow any specific instructions given by my healthcare team

Results:

  • I will review your images and prepare a report

  • My office will always have a follow-up visit scheduled to discuss your results face-to-face very shortly after you complete the test

  • Even if the results are completely normal, it is important that all of your questions are answered

  • Results will also be available through your patient portal

Important Safety Information

Radiation Exposure:

  • The amount of radiation is small and comparable to other medical imaging tests

  • The tracer is eliminated from your body naturally within 1-2 days

  • Drink extra fluids for 24 hours after your test to help elimination

Pregnancy and Breastfeeding:

  • Inform us if you are pregnant or might be pregnant

  • If breastfeeding, you may need to pump and discard breast milk for 24 hours after the test

Emergency Situations: Call my office immediately if you experience:

  • Severe chest pain

  • Difficulty breathing

  • Severe dizziness or fainting

  • Irregular heartbeat that persists

Contact Information

Questions About Your Test: Dr. Rasch's Office: [Phone Number] Hours: Monday-Friday, 8:00 AM - 5:00 PM

After-Hours Emergencies: [Hospital Name] Emergency Department: [Phone Number] Or call 911 for life-threatening emergencies

Test Results: Dr. Rasch's Office: [Phone Number] Patient Portal: damianrasch.com

Frequently Asked Questions

Q: Is the test safe? A: Yes, nuclear stress tests are very safe. The amount of radiation exposure is small and similar to other common medical imaging tests. In my practice, serious complications are rare, occurring in less than 1 in 500 tests.

Q: Will I be radioactive after the test? A: The radioactive tracer I use is very small and short-lived. You are not dangerous to be around others, including children and pregnant women. The tracer leaves your body naturally through urine within 1-2 days.

Q: What if I can't complete the exercise portion? A: That's perfectly fine and provides valuable information to me about your heart function. I can also use medication to stress your heart if needed. The goal is to safely reach your target heart rate.

Q: Can I drive myself home? A: Yes, most of my patients can drive themselves home after the test. However, if you receive sedation or feel unwell, please arrange for someone to drive you.

Q: What if I have claustrophobia? A: The camera does not enclose you like an MRI machine. You'll lie on an open table with the camera moving around you. Let my staff know about any concerns beforehand.

Q: Why do I need to avoid caffeine? A: Caffeine can interfere with the medications used during the stress portion of the test and may affect the accuracy of your results.

Q: What if I forget and have caffeine? A: Please call my office immediately. Depending on the timing and amount, we may need to reschedule your test.

Q: How accurate is this test? A: Nuclear stress tests are highly accurate, correctly identifying heart problems about 85-90% of the time. However, no test is 100% perfect, and I may recommend additional testing if needed.

Q: Will my insurance cover this test? A: Most insurance plans cover nuclear stress tests when ordered by a physician for appropriate medical reasons. Check with your insurance provider if you have specific coverage questions.

Q: How much radiation will I receive during this test? A: A nuclear stress test typically delivers about 9-12 millisieverts (mSv) of radiation exposure. To put this in perspective, this is roughly equivalent to one chest CT scan. The radiation comes from gamma rays emitted by the radioactive tracer, which are different from the X-rays used in regular X-ray imaging. Gamma rays are similar to X-rays but have higher energy and can penetrate deeper into tissue, allowing us to create detailed images of your heart's blood flow. The tracer is specially designed to be eliminated quickly from your body, minimizing your total exposure.

Q: Can I eat after the test? A: Yes, you can resume your normal diet immediately after completing the test.

Q: What if I take diabetes medication? A: We will discuss your medication timing before the test. You may need to adjust your insulin or other diabetes medications due to the fasting requirement.

This handout provides general information about nuclear stress testing in Dr. Rasch's practice. Your specific instructions may vary based on your individual medical condition. Always follow the specific directions given by your own physician and your healthcare team. This handout is for informational purposes and does not constitute medical advice.

Published by damianrasch.com