Test Overview

A cardiac perfusion scan measures the amount of blood in your heart
muscle at rest and during exercise. It is often done to find out what may be
causing symptoms like angina (such as chest pain or pressure). It may be done after a
heart attack to see if areas of the heart are not
getting enough blood or to find out how much heart muscle has been damaged from
the heart attack.

During the scan, a camera takes pictures of the heart after a
special test medicine (radioactive tracer) is given through an IV. The tracer travels through the blood and into the heart
muscle. As the tracer moves through the heart muscle, areas that have good
blood flow absorb the tracer. Areas that do not absorb tracer may not be
getting enough blood or may have been damaged by a heart attack.

Two sets of pictures may be made during a cardiac perfusion scan.
One set is taken while you are resting. Another set is taken after your heart
has been stressed, either by exercise or after you have been given a medicine.
The resting pictures are then compared with the stress images.

This test is also known by other names including myocardial perfusion scan, myocardial perfusion imaging, thallium scan, sestamibi cardiac scan, and nuclear stress test.

Why It Is Done

A cardiac perfusion scan is done to:

  • Find the cause of unexplained chest pain or pressure.
  • Find the cause of chest pain or pressure brought on by exercise.
  • Check for the location and
    amount of damage caused by a heart attack.
  • Identify
    coronary artery disease (CAD).
  • Help make
    treatment decisions for a person with CAD.
  • Check to see that the heart is getting enough blood after heart
    surgery or angioplasty.
  • Identify a
    congenital heart defect and determine how serious it
    is. These scans may also be done following surgery to correct a congenital
    heart defect.

How To Prepare

Before a cardiac perfusion, tell your doctor if you:

  • Are taking any medicines, including
    erection-enhancing medicines (such as Cialis, Levitra, or Viagra). You may need
    to take nitroglycerin during this test, which can cause a serious reaction if
    you have taken an erection-enhancing medicine within the previous 48 hours. Ask
    your doctor whether you need to stop taking any of your other medicines before
    the test.
  • Are allergic to any medicines or
    anesthetics.
  • Are or might be pregnant.
  • Are
    breastfeeding. The radioactive tracer used in this test can get into your breast milk. Do not breastfeed your baby for 2 days after this test. During this time, you can give your baby breast milk you stored before the test, or you can give formula. Discard the breast milk you pump for 2 days after the test.

Do not eat or drink for at least 3 hours before a cardiac perfusion
scan. If you are having a stress scan, avoid alcohol, tobacco, caffeinated
beverages, and nonprescription medicines for at least 24 hours before the test.

Wear comfortable shoes and loose shorts or pants suitable for
exercise. Remove all jewelry before the test.

Talk to your doctor about any concerns you have regarding the need
for the test, its risks, how it will be done, or what the results may mean.
To help you understand the importance of this test, fill out the
medical test information form (What is a PDF document?).

How It Is Done

A cardiac perfusion scan is usually done in a hospital radiology or
nuclear medicine department, a doctor’s office, or at an outpatient clinic. The
test is done by a doctor and technologist trained in
nuclear medicine.

Resting scan

For resting scans, in which you do not exercise, you will be
asked to remove your clothing above the waist, and you will be given a hospital
gown to wear. Electrodes might be attached to your chest to keep track of
your heartbeats.

You will have a very thin tube, called an IV, going into your arm or hand. A small amount of the
radioactive tracer will be put in the IV.

You will lie on your back on a table with a large camera
positioned above your chest. The camera records the tracer’s signals as it
moves through your blood. The camera does not produce any radiation, so you are
not exposed to any additional radiation while the scan is being done.

You will be asked to remain very still during each scan, which
takes 5 to 10 minutes. The camera will move to take more pictures at different
angles. Several scans will be taken.

The entire test takes 30 to 40 minutes, after which you can
resume your normal activities.

Stress scan using medicine

The stress scan is done in two parts. In many hospitals, the
first images are taken while the person is at rest. Then a second set of images
is taken after the person is given a medicine such as adenosine,
which makes the heart respond like it would to exercise. Sometimes the stress scan is done first and the resting scan might be done the next day.

A stress test with
medicine is usually used when a person cannot exercise for some reason.

For this test, you will be asked to sit or lie on the examining
table and you will be given a routine electrocardiogram (EKG or ECG), which takes
about 5 to 10 minutes.

Then you will be given the medicine through your IV. You may get a
headache and feel dizzy, flushed, and nauseated from the medicine, but these
symptoms usually do not last long. Additional EKGs and blood pressure
measurements are often taken. After the medicine takes effect (about 4
minutes), a small amount of radioactive tracer is given through your IV.

You will wait about 30 to 60 minutes. You might be asked to eat or drink something. Then you will lie down
on a table for a set of scans. The camera records the tracer’s signals as it
moves through your blood. The camera does not produce any radiation, so you are
not exposed to any more radiation while the scan is being done.

Sometimes more pictures are taken after you rest for 2 to 4
hours. Most people can resume their normal diet and activities after the final set of
scans.

Stress scan using exercise

For stress scans using exercise, your heart rate will be checked
with an
electrocardiogram (EKG or ECG). Because EKG electrodes need
to be attached to the chest to check the heart, men are usually bare-chested
and women usually wear a bra, gown, or loose shirt. To learn more, see
the topic Electrocardiogram.

The exercise stress scan is done in two parts. First a set of
resting images is taken, then a set of stress images is taken immediately after
exercise. Sometimes the stress scan is done first and the resting scan might be done the next day.

In many hospitals, first resting pictures are taken using one type of
tracer. More pictures are taken using a different tracer after your heart has
been stressed by exercise.

In this stress test, you exercise on a treadmill or stationary
bike. Your heart rate will be checked during the test with standard
electrocardiography. Your blood pressure is checked using a blood pressure cuff
placed on your arm. To learn more, see the topic
Exercise Electrocardiogram.

You will begin by walking or pedaling slowly and easily. Every
few minutes, the speed or incline of the treadmill or resistance of the bike
may be increased. You will exercise until you need to stop or until you reach a
suitable heart rate. At that point, you will be given a different tracer medicine through your IV.

You will then lie down on a table for scanning. Each scan takes 5
to 10 minutes. The camera does not produce any radiation, so you are not
exposed to any additional radiation while the scan is being done.

Sometimes more pictures are taken after you rest for 30 minutes
to 4 hours. In some hospitals, you are given more radioactive tracer several hours after exercise and before the final image.

Most people can resume their normal diet and activities after the
final set of scans.

Drink plenty of fluids for the next 24 hours to help flush the tracer out of your body. If you have kidney,
heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount
of fluids you drink.

How It Feels

The cardiac scanning test itself is painless.

  • You may feel a brief stinging or burning
    sensation when the IV is inserted into your vein.
  • You may be uncomfortable lying still for an extended period of
    time on the table during the scans.
  • If medicine to stress your
    heart is used, you may have symptoms of mild nausea, headache, dizziness,
    flushing, or chest pain. These symptoms only last a few
    minutes.
  • If you are asked to exercise, you may have chest pain,
    breathlessness, lightheadedness, aching in your leg muscles, and fatigue.
    Report these to the technician. If the symptoms are severe, the exercise part
    of the test may be stopped.
  • You will be asked to remain very still during each scan, which takes about 5 to 10 minutes. The camera will move to take more pictures at different angles. Several scans will be taken.

Risks

Cardiac perfusion scans are usually safe. There is always a slight
chance of damage to cells or tissue from radiation, including the low levels of
radiation used for this test. But the chance of damage from the radiation is
usually very low compared with the benefits of the test.

The risk of exercise depends on the condition of your heart and
your general level of health. The risks include:

  • Fainting.
  • Chest
    pain.
  • An irregular heartbeat.
  • Heart attack.
    There is a slight risk that death may result if a heart attack occurs during
    the test.

After the test

Call 911 or other emergency
services immediately if you develop:

  • Chest pain or pressure.
  • Trouble breathing.

Results

Test results are usually available within 1
to 3 days.

A cardiac perfusion scan measures the amount of blood in your heart
muscle at rest and during exercise.

Results are:footnote 1

  • Normal if radioactive tracer is evenly distributed throughout
    your heart muscle.
  • Abnormal if areas of abnormal tracer absorption are
    present. This means some areas of heart muscle are not getting enough blood
    (ischemia). This may mean that the heart has been damaged or that coronary artery
    disease is present.

What Affects the Test

Reasons you may not be able to have the test or why the results may
not be helpful include:

  • A recent, serious
    heart attack.
  • Inflammation of the heart,
    such as
    myocarditis or
    sarcoidosis.
  • Bruising of the heart muscle
    (cardiac contusion).
  • Weakening of the heart
    muscle.
  • Stiffening of the heart muscle (myocardial
    fibrosis).
  • A severely narrowed heart valve.
  • Implanted
    cardiac devices, such as a
    pacemaker.
  • A condition that makes it difficult to exercise, such as lung
    disease,
    arthritis, or a neuromuscular
    problem.
  • Some medicines, such as dipyridamole (Persantine) and
    pentoxifylline (Trental).
  • Severe
    electrolyte imbalances (especially calcium, potassium,
    sodium, or magnesium).
  • Pregnancy or breastfeeding (except in an
    emergency).

Test results may be difficult to interpret in scans done on women
with large breasts.

What To Think About

Stress testing using medicine may be done
instead of exercise stress testing for older adults and people with conditions
that may make exercise difficult, such as those who are
obese or those who have
chronic obstructive pulmonary disease (COPD),
peripheral arterial disease, spinal cord injury,
arthritis, or
multiple sclerosis.

Other tests also may be done to evaluate your heart. To learn more, see:

Other Places To Get Help

Organizations

American Heart Association
www.heart.org

National Heart, Lung, and Blood Institute (U.S.)
www.nhlbi.nih.gov

References

Citations

  1. Fischbach F, Dunning MB III (2015). A Manual of Laboratory and Diagnostic Tests, 9th ed. Philadelphia: Wolters Kluwer Health.

Other Works Consulted

  • Chernecky CC, Berger BJ (2013). Laboratory Tests and Diagnostic Procedures, 6th ed. St. Louis: Saunders.
  • Fischbach F, Dunning MB III (2015). A Manual of Laboratory and Diagnostic Tests, 9th ed. Philadelphia: Wolters Kluwer Health.
  • Klocke FJ, et al. (2003). ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging-Executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 108(11): 1404-1418. Available online: http://circ.ahajournals.org/content/vol108/issue11/index.shtml.

Credits

ByHealthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC – Cardiology, Electrophysiology
E. Gregory Thompson, MD – Internal Medicine
Specialist Medical Reviewer George Philippides, MD – Cardiology

Current as ofOctober 5, 2017