Overview
A nuclear stress test combines radioactive tracer imaging with exercise or pharmacological stress to evaluate myocardial perfusion and cardiac function.
Pre-Test Requirements
Patient Preparation
- NPO for 4-6 hours before test
- Hold beta-blockers for 24-48 hours (per physician discretion)
- Hold caffeine for 24 hours
- Comfortable clothing and walking shoes
- Current medication list
Equipment Verification
- Gamma camera operational check
- Radiopharmaceutical dose preparation
- Treadmill/pharmacological stress agents ready
- Emergency cart checked
Procedure Steps
1. Rest Phase
- Obtain baseline vitals and 12-lead ECG
- Establish IV access
- Administer rest dose of radiotracer (typically Tc-99m sestamibi)
- Wait 30-60 minutes for uptake
- Acquire rest images
2. Stress Phase
Exercise Protocol
- Begin Bruce or Modified Bruce protocol
- Monitor ECG, BP every 2-3 minutes
- Inject stress dose at peak exercise
- Continue exercise for 1-2 minutes post-injection
Pharmacologic Protocol
- Administer vasodilator (adenosine, regadenoson, or dipyridamole)
- Monitor vital signs
- Inject stress dose at peak effect
- Continue monitoring for 3-5 minutes
3. Image Acquisition
- Wait 15-30 minutes post-stress
- Position patient under camera
- Acquire SPECT images
- Process and reconstruct images
Documentation Requirements
- Vital signs throughout procedure
- ECG strips and any changes
- Medications administered
- Exercise duration/workload
- Symptoms during test
- Technical factors
Safety Considerations
- Emergency response protocol
- Radiation safety measures
- Contraindications review
- Pregnancy screening
Quality Control
- Image quality assessment
- Motion correction if needed
- Attenuation correction when applicable
Reporting
- Raw data analysis
- Perfusion assessment
- Wall motion evaluation
- Ejection fraction calculation
- Final interpretation
References
ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria