Cardiac Stress Testing What Stress is Best?
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1 Cardiac Stress Testing What Stress is Best? Jennifer Gerryts, Registered Respiratory Therapist Kati Tuomi, Medical Radiation Technologist, Nuclear Medicine Thunder Bay Regional Health Sciences Centre 1
2 Presenter Disclosure Jennifer Gerryts and Kati Tuomi Relationships with commercial interests: None I have no conflict of interest or affiliations that have influenced this presentation to disclose 2
3 Disclosure of Commercial Support This program has not received financial or in-kind support Potential for conflict(s) of interest : Jennifer Gerryts and Kati Tuomi has not received payment/funding, etc. from an organization supporting this program AND/OR organization whose product(s) are being discussed in this program]. 3
4 Learning Objectives Describe the differences between a stress test and a nuclear stress test Differentiate the clinical indications for a stress test and a nuclear stress test 4
5 What is a Stress Test? Diagnostic tool in the management and evaluation of patients with known or suspected heart disease Aids in assessing the risk related to CHD Evaluation of efficacy of therapeutic interventions Exercise electrocardiography is the most common Can be combined with imaging (MPI) 5
6 Indications For Stress Testing Symptoms suggesting angina (stable) Patients with known coronary heart disease with new or worsening symptoms Acute coronary syndrome (ACS) Coronary revascularization Valvular heart disease Pre-op Changes in resting ECG 6
7 General Contraindications Acute myocardial infarction (within two days) Ongoing unstable angina Uncontrolled arrhythmias with hemodynamic compromise Symptomatic severe valvular stenosis Acute aortic dissection Acute pulmonary embolism, pulmonary infarction, or deep venous thrombosis Physical disability that precludes safe and adequate testing 7
8 Contraindications For Stress Testing Exercise Stress Test De-condition/Unable Beta Blocker LVH (hides ischemia) Left Bundle Branch, Right Bundle Branch (V2, V3) Ventricular Paced Rhythm Greater than 1 mm ST depression at rest Hypertension Pharmacological Stress Test (Persantine) Severe Asthma Caffeine within 24hrs Medications: aggrenox 2 nd or 3 rd degree block without pacemaker 8
9 Choosing The Optimal Stress Test Clinical Indication / Patient History? Can the Patient Exercise? Does the patient have a large body habitus? Lung Disease? Abnormal resting ECG? Contraindications? 9
10 Stress Test Protocol Differences 1. Exercise Stress Test 2. Cardiolite Stress Test (Exercise) 3. Persantine Stress Test 10
11 Positive Exercise Stress Test V tach ( 3 or more PVCs in a row) ST depression ST horizontal ST elevation 11
12 Myocardial Perfusion Imaging 12
13 Protocol Fasting for 4 hours prior to test Caffeine free for 24 hours Sestamibi Technetium 99m Low rest dose high stress dose 2 day procedure for high BMIs Injection at rest -60 minute wait until images Stress injection minute wait until images
14 How? Vasodilation of arteries to heart muscle Rest vs stress More workload put on heart during stress Improper patient preparation or sub optimal stress test can lead to false negatives
15 Gamma Camera Acquires an image from the gamma rays Low dose CT used for attenuation correction Patient considerations Lie flat Claustrophobia Tolerate protocol
16 Raw Data
17 Processing
18
19 Normal
20
21 MI
22
23 Ischemia
24
25 References M. Kacmarek, Robert. Dimas, Steven. W. Mack, Craig. (2005). The Essentials of Respiratory Care, Fourth Edition. St. Louis, Missouri: Mosby. Inc. Des Jardins, Terry. G. Burton, George. (2011). Clinical Manifestations and Assessment of Respiratory Disease. Maryland Heights, Missouri: Mosby. Inc. A. Alessi, BS, CNMT, NCT, RT(N). (2010). Nuclear Cardiology Technology Study Guide. Reston, VA: Society of Nuclear Medicine. Inc. Up To Date. (2018). Noninvasive Ventilation in Selecting The Optimal Stress Test. Contraindications. Indications, Clinical Factors, Optimal Tests. Retrieved April 1, 2018, from k=1 American Society of Nuclear Cardiology 25
26 Please Complete the Online Evaluation Your feedback is important to us! Your feedback will allow the Cardiovascular and Stroke Summit Planning Committee to evaluate the 2018 Summit, to provide feedback to the speakers, & develop future educational events Scan QR code OR Go To
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