Procedure
An informed consent must be signed before the procedure by the patient and performing physician. An IV will be started and a brief medical history will be obtained. Resting X-ray pictures will be taken after the first injection of the isotope. The patient will have to lie very still with the left arm over their head during the scans.

For the exercise stress test, the patient is attached to an ECG machine to monitor their heart throughout the procedure. This is done by applying sticky electrode patches to their chest area. A resting ECG and blood pressure are taken before the procedure for comparison. When the physician arrives, the patient will begin to either walk on a treadmill with varying speeds and elevations or they will pedal a bicycle with increasing intensity every few minutes. When the physician determines that the patient has walked long enough, the heart rate is high enough, the patient is too tired or abnormalities are noted, the isotope will be injected for the second time. The patient will slow down on the bicycle/treadmill to cool down for one minute.

After the test, the patient will sit in a chair to rest for an additional few minutes. They will continue to have their heart rate, blood pressure or EKG monitored for four or five minutes or until it returns to normal. The patient will be given a fatty snack to clear the isotope from the liver.

The physician may give the patient a preliminary report. Otherwise, the entire test will be reviewed by the physician and a report dictated. This report will be sent to the ordering physician and any referring physicians noted. The ordering physician will then discuss the results with their patient.

What You Should Know
On the day of the test you should register with Outpatient Registration Area on first floor of the Medical Center behind the Information Desk. Plan to arrive two hours before the scheduled stress test time. Following registration, you will be directed to Nuclear Medicine in Radiology on the first floor. The entire procedure takes about three hours.

To Prepare for This Test:

• No Solid Foods for Two Hours Before the Test
• Wear Comfortable Walking Shoes
• No Smoking for Two Hours Before the Test
• Take Medications as Normal Unless Otherwise Indicated by Your Physician
• No Viagra 24 Hours Before the Test
• No Caffeinated Coffee, Tea or Colas 24 Hours Prior to the Test (Decaf is Acceptable, But Avoidance of All Such Beverages is Preferred). No Chocolate or Cocoa Either. You May Drink Water.
• Wear Slacks if Possible - No One Piece Jump Suits

For this test, Medicare in Ohio has determined that it must meet certain medical criteria. A local Medical Review Policy (LMRP) letter details the diagnoses that are acceptable. It will be necessary to provide an ICD-9 diagnosis or a set of signs and symptoms from which a diagnosis can be determined. If the reason for the test does not match the Medicare requirement, the test will still be performed. However, you must sign an Advanced Beneficiary Notification (ABN) before receiving the test.

During the test, you will lie down while receiving a rapid injection of Persantine (drug) IV to increase the heart rate. An IV is inserted before the test and an isotope is injected at rest and again after the drug is infused. X-rays are taken after each injection. The patient is given a fatty snack after the second injection to allow the isotope to clear from the liver. A qualified physician supervises the infusion of the drug.

Procedure
An IV will be started and a brief medical history will be obtained. Resting X-ray pictures will be taken after the first injection of the isotope. The patient will have to lie very still with their left arm over their head during the scans.

For the pharmacological stress test, the patient is attached to an ECG machine to monitor their heart throughout the procedure. This is done by applying sticky electrode patches to their chest area. A resting ECG and blood pressure are taken before the procedure for comparison. When the physician arrives, the drug will be rapidly infused over a three to four minute period. Toward the end of the infusion, the isotope will be injected for the second time.

After the test and the infusion of the drug is complete, the patient will continue to have their heart rate, blood pressure or ECG monitored for approximately 20 minutes or until return to baseline. The patient will be given a fatty snack to clear the isotope from the liver. The physician may give the patient a preliminary report. Otherwise, the entire test will be reviewed by the physician and a report dictated. This report will be sent to the ordering physician and any referring physicians noted. The ordering physician will then discuss the results with their patient.

To Prepare for This Test:

• No Solid Foods for Two Hours Before the Test
• Wear Comfortable Walking Shoes
• No Smoking for Two Hours Before the Test
• Take Medications as Normal Unless Otherwise Indicated by Your Physician
• No Viagra 24 Hours Prior to the Test
• No Caffeinated Coffee, Tea or Colas 24 Hours Prior to the Test (Decaf is Acceptable but Avoidance of All Such Beverages is Preferred). No Chocolate or Cocoa Either. You May Drink Water.
• Wear Slacks if Possible - No One Piece Jump Suits
• Restrict Xanthine Medications for 36-48 Hours Before the Test as They Will Interfere with the Results