This diagnostic test is performed to help detect coronary artery disease (CAD), which is inadequate blood supply to the heart often caused by blocked arteries.

Nuclear Exercise Stress Test

1 Day Nuclear Exercise Stress Test

1 Day Nuclear Exercise Stress Test

The technologist will insert an intravenous (IV) line into a vein in your arm or hand in order to inject a small amount of Cardiolite, which is a radioactive tracer that is carried by the bloodstream to your heart. Approximately 45 minutes to 1 hour after the injection, the technologist will take pictures of your heart for about 10-15 minutes with a gamma camera that detects the radioactive injection. You will either be sitting upright or reclined on the imaging chair. It is very important to breathe normally and remain still while you are being imaged. These images represent the blood supply to the heart at rest.

Once the first set of images are complete, you will be prepared for the exercise stress test. ECG electrodes will be placed on your chest to monitor your heart rhythm throughout the test. You will then begin to exercise on a treadmill, during which your heart rate, blood pressure, and ECG will be continuously monitored. Once you have achieved your target heart rate, a second dose of Cardiolite will be injected through the intravenous line, and you will continue exercising for an additional 1-2 minutes. If blood flow to the heart is limited due to CAD, then the amount of Cardiolite delivered to the heart is reduced. Following the exercise stress test, the IV will be removed. You will be asked to eat prior to the second set of images, as eating helps to improve the image quality. The technologist will advise you when to return for imaging (approximately 45 minutes to 1 hour after the stress test). 1 or 2 stress images will be acquired (sitting upright and/or reclined), and this will take about 5-10 minutes. The second set of images represent the blood supply to the heart at stress. Once the stress images are acquired, the test is complete.

2 Day Nuclear Exercise Stress Test

2-Day Nuclear Exercise Stress Test

On Day 1, the rest component of the study will be performed. The technologist will insert an intravenous (IV) line into a vein in your arm or hand in order to inject a small amount of Cardiolite, which is a radioactive tracer that is carried by the bloodstream to your heart. The IV will be removed after the injection is complete. Following the injection, you will be asked to eat prior to imaging, as eating helps to improve the image quality. Approximately 45 minutes to 1 hour after the injection, the technologist will take pictures of your heart for about 10-15 minutes with a gamma camera that detects the radioactive injection. You will either be sitting upright or reclined on the imaging chair. It is very important to breathe normally and remain still while you are being imaged. These images represent the blood supply to the heart at rest. Once the rest images are acquired, the first half of the test is complete.

On Day 2, the stress component of the study will be performed. The technologist will insert an IV prior to starting your stress test. ECG electrodes will be placed on your chest to monitor your heart rhythm throughout the test. You will then begin to exercise on a treadmill, during which your heart rate, blood pressure, and ECG will be continuously monitored. Once you have achieved your target heart rate, a second dose of Cardiolite will be injected through the IV, and you will continue exercising for an additional 1-2 minutes. If blood flow to the heart is limited due to CAD, then the amount of Cardiolite delivered to the heart is reduced. Following the exercise stress test, the IV will be removed. You will be asked to eat prior to the second set of images, as eating helps to improve the image quality. The technologist will advise you when to return for imaging (approximately 45 minutes to 1 hour after the stress test). 1 or 2 stress images will be acquired (sitting upright and/or reclined), and this will take about 15-20 minutes. The second set of images represent the blood supply to the heart at stress. Once the stress images are acquired, the test is complete.

Nuclear Persantine Stress Test

1 Day Nuclear Persantine Stress Test

1-Day Nuclear Persantine Stress Test

The technologist will insert an intravenous (IV) line into a vein in your arm or hand in order to inject a small amount of Cardiolite, which is a radioactive tracer that is carried by the bloodstream to your heart. Approximately 45 minutes to 1 hour after the injection, the technologist will take pictures of your heart for about 10-15 minutes with a gamma camera that detects the radioactive injection. You will either be sitting upright or reclined on the imaging chair. It is very important to breathe normally and remain still while you are being imaged. These images represent the blood supply to the heart at rest.

Once the first set of images are complete, you will be prepared for the Persantine stress test. ECG electrodes will be placed on your chest to monitor your heart rhythm throughout the test. A drug called Persantine will slowly be injected though the intravenous line in order to dilate the coronary arteries (similar to the effect of physical exercise). Your heart rate, blood pressure, and ECG will be continuously monitored for any changes. A second dose of Cardiolite will also be injected through the IV. If blood flow to the heart is limited due to CAD, then the amount of Cardiolite delivered to the heart is reduced.

During the Persantine stress test, you may experience some side effects, such as headache, dizziness, chest discomfort, abdominal discomfort, nausea, or a warm flushing sensation. These effects are temporary and only last for a few minutes. An antidote called Aminophylline is readily available to reverse the side effects of Persantine shortly after the Cardiolite injection. Following the Persantine stress test, the IV will be removed. You will be asked to eat prior to the second set of images, as eating helps to improve the image quality. The technologist will advise you when to return for imaging (approximately 1 hour after the Persantine stress test). 1 or 2 stress images will be acquired (sitting upright and/or reclined), and this will take about 5-10 minutes. The second set of images represent the blood supply to the heart at stress. Once the stress images are acquired, the test is complete.

2 Day Nuclear Persantine Stress Test

2 Day Nuclear Persantine Stress Test

On Day 1, the rest component of the study will be performed. The technologist will insert an intravenous (IV) line into a vein in your arm or hand in order to inject a small amount of Cardiolite, which is a radioactive tracer that is carried by the bloodstream to your heart. The IV will be removed after the injection is complete. Following the injection, you will be asked to eat prior to imaging, as eating helps to improve the image quality. Approximately 45 minutes to 1 hour after the injection, the technologist will take pictures of your heart for about 10-15 minutes with a gamma camera that detects the radioactive injection. You will either be sitting upright or reclined on the imaging chair. It is very important to breathe normally and remain still while you are being imaged. These images represent the blood supply to the heart at rest. Once the rest images are acquired, the first half of the test is complete.

On Day 2, the stress component of the study will be performed. The technologist will insert an IV prior to starting your stress test. ECG electrodes will be placed on your chest to monitor your heart rhythm throughout the test. A drug called Persantine will slowly be injected though the intravenous line in order to dilate the coronary arteries (similar to the effect of physical exercise). Your heart rate, blood pressure, and ECG will be continuously monitored for any changes. A second dose of Cardiolite will also be injected through the IV. If blood flow to the heart is limited due to CAD, then the amount of Cardiolite delivered to the heart is reduced.

During the Persantine stress test, you may experience some side effects, such as headache, dizziness, chest discomfort, abdominal discomfort, nausea, or a warm flushing sensation. These effects are temporary and only last for a few minutes. An antidote called Aminophylline is readily available to reverse the side effects of Persantine shortly after the Cardiolite injection. Following the Persantine stress test, the IV will be removed. You will be asked to eat prior to the second set of images, as eating helps to improve the image quality. The technologist will advise you when to return for imaging (approximately 1 hour after the Persantine stress test). 1 or 2 stress images will be acquired (sitting upright and/or reclined), and this will take about 15-20 minutes. The second set of images represent the blood supply to the heart at stress. Once the stress images are acquired, the test is complete.

How to Prepare for a Nuclear Stress Test

Preparation for a 1-Day Protocol

  • No caffeine consumption for 24 hours prior to the test (no coffee, tea, decaffeinated drinks, herbal teas, chocolate, or pop).
  • Nothing to eat or drink for 4 hours prior to the test (2 hours for diabetic patients); water is allowed.
  • Wear comfortable clothing with no metal zippers or metal buttons on the shirt.
  • Wear comfortable shoes if you are having an exercise stress test.
  • Bring something to eat (such as a sandwich, bagel, etc.).
  • Bring a list of your current medications.
  • Consult with your physician about whether you need to stop any medications prior to the test, such as beta blockers (bisoprolol, metoprolol, atenolol), Aggrenox, Theophylline, or Tylenol #3.

Preparation for a 2-Day Protocol

For Day 1 (Rest Scan):

  • No caffeine consumption on the morning of the test (no coffee, tea, decaffeinated drinks, herbal teas, chocolate, or pop).
  • Nothing to eat or drink for 4 hours prior to the test (2 hours for diabetic patients); water is allowed.
  • Wear comfortable clothing with no metal zippers or metal buttons on the shirt.
  • Bring something to eat (such as a sandwich, bagel, etc.).
  • Bring a list of your current medications.
  • Consult with your physician about whether you need to stop any medications prior to the test, such as beta blockers (bisoprolol, metoprolol, atenolol), Aggrenox, Theophylline, or Tylenol #3.

 For Day 2 (Stress Test):

  • No caffeine consumption for 24 hours prior to the test (no coffee, tea, decaffeinated drinks, herbal teas, chocolate, or pop).
  • Nothing to eat or drink for 4 hours prior to the test (2 hours for diabetic patients); water is allowed.
  • Wear comfortable clothing with no metal zippers or metal buttons on the shirt.
  • Wear comfortable shoes if you are having an exercise stress test.
  • Bring something to eat (such as a sandwich, bagel, etc.).
  • Consult with your physician about whether you need to stop any medications prior to the test, such as beta blockers (bisoprolol, metoprolol, atenolol), Aggrenox, Theophylline, or Tylenol #3.

Frequently Asked Questions

What is the difference between a 1-day protocol and a 2-day protocol?

For the 1-day protocol, both the rest and stress portions of the test are performed on the same day, and the test takes approximately 3-4 hours. The 1-day protocol also involves receiving a higher radiation dose. For the 2-day protocol, the rest and stress portions of the test are split into 2 separate days. The rest component takes approximately 1.5-2 hours, and the stress component takes approximately 2 hours. The 2 day protocol is recommended as it involves a lower radiation dose.

What is the difference between an Exercise Stress Test and a Persantine Stress Test?

An exercise stress test involves you walking on a treadmill in order to put the heart in a stress state. However, if you are unable to walk on a treadmill, or if you have certain arrhythmias or ECG abnormalities, similar results can be achieved using a drug called Persantine. Persantine dilates the blood vessels of the heart in order to simulate a stress state, similar to what naturally occurs during physical exercise.

Can I drive/work/travel once the test is completed?

Yes, you can resume your normal activities after the test, such as driving and working. If you are travelling by plane or crossing the border within one week after your test, please inform the technologist. If you will have close contact with pregnant women or young children, please inform the technologist.

I am a diabetic patient. When will I be allowed to eat and take my medication?

If you are completing a 1-day protocol, you will be allowed to eat and resume your normal medications once the stress test is complete. If you are feeling unwell at any time, please inform the technologist. If you are completing a 2-day protocol, you will be allowed to eat and resume your medications immediately after the injection on both days (except if you have been instructed to discontinue any medications prior to the stress test). The 2-day protocol is recommended for diabetic patients as it minimizes the delay in eating.

Why is my height and weight required when booking the test?

We require your height and weight in order to calculate your body mass index (BMI). In an effort to reduce the radiation exposure for patients, we strive to match the radioactive injection to your body size. For example, a person who is 5’5” and 120 lbs will receive a lower radioactive dose than someone who is 5’5” and 250 lbs.

How much radiation will I be exposed to?

The radiation dose from a conventional 1-day protocol for the nuclear stress test is similar to that from a chest CT or CT coronary angiogram. However, our state-of-the-art gamma camera allows us to significantly decrease the radiation dose for our patients without compromising image quality or diagnostic accuracy. Typically, our 1-day protocol patients will receive half the radioactive dose compared to conventional 1-day protocols.

We recommend a 2-day protocol for nuclear stress testing because the radiation dose is further decreased, as the low-dose radioactive injections are split between two days.

Refer to the charts below to estimate and compare your radiation exposure from Nuclear Cardiology Exams versus other common imaging exams.

Nuclear Cardiology Exams and Associated Patient Radiation Doses

ExamInjected ActivityEffective Radiation Dose Estimate
1 Day Rest/Stress Tc-99m based3-6 mCi Rest9-18 mCi Stress1-2 mSv Tc-99 Sestamibi3-6 mSv Tc-99m Sestamibi
2 Day Rest/Stress or Stress/RestTc-99m based3-6 mCi Rest5-8 mCi Stress1-2mSv Tc-99m Sestamibi1.7-2.6 mSv Tc-99m Sestamibi
MUGA Tc-99m RBC10-12mCi3-3.6 mSv Tc-99m RBC

Effective Radiation Doses from Other Common Imaging Exams

Radiation SourcesMean mSv
Background radiation in Canada1.8
Echocardiogram0
MRI0
Chest x-ray0.05
Mammogram0.7
Calcium Scoring Test1-2
Cardiac Catheterization7
Percutaneous Coronary Intervention17
Chest CT10
Coronary CT Angiography3-14
1-Day Myocardial Perfusion Imaging4-8
2-Day Myocardial Perfusion Imaging2.7-4.6
F-18 FDG PET5

Will I feel different after I’m injected with Cardiolite?

You will not feel anything different after the radioactive injection. However, the potential for any adverse effects or allergic reaction is rare.

How long will the radioactivity stay in my body?

The radioactive isotope used for imaging is 99mTechnetium, which has a half-life of 6 hours. Most of the isotope is eliminated in the first 24 hours after the injection. It is excreted through the urine, but you will not notice any difference. Residual amount of the tracer will remain for approximately 2-3 days.

Are there any contraindications?

Nuclear stress tests are not routinely performed on females who are pregnant or could potentially be pregnant. If you are pregnant or breastfeeding, or if there is a possibility of pregnancy, please consult with your physician.

Who can I contact if I have more questions?

Please feel free to contact the clinic at 416-297-8362.