Procedures

Cardiac stress test with imaging

Massachusetts General Hospital Imaging provides cardiac stress tests in a caring environment using the latest technology, and every scan is interpreted by a radiologist with specialty training.

Cardiac Stress Scan

Massachusetts General Hospital Imaging provides cardiac stress tests with imaging on the Mass General main campus. Our staff places priority on making your journey through the imaging process comfortable, safe, and successful. All images are read by a radiologist with specialty expertise in the area of the body being studied.

Cardiac stress test overview:

  • A stress test looks at blood flow to your heart both before and after you engage in exercise. (In some cases a medicine that speeds up the heart, called a pharmacologic stress agent, is used instead of exercise.)
  • A stress test is a type of nuclear medicine exam: you receive a radioactive tracer that highlights your blood so a special camera can see it easily.
  • A stress test is used to evaluate the cause of chest pain or measure the strength of your heart after a heart attack or surgery, for example.
  • We pay special attention to minimizing radiation exposure while still obtaining the highest quality images.
  • All cardiac stress tests are jointly read by a radiologist and a cardiologist specially trained in nuclear medicine.
  • You should not eat or drink anything for three hours before your test
  • You should not smoke or consume caffeine for 24 hours before your appointment.
  • You should wear walking shoes and a comfortable two-piece outfit.
  • An IV will be used to inject the tracer. You will also be attached to a heart monitor.
  • We will inject the tracer and capture images two times: first while you are at rest and then either as you exercise by walking on a treadmill or after you take a medicine that speeds up the heart.
  • The exam process takes two to three hours in total.

Cardiac stress test in depth

What is a cardiac stress test with imaging?

A stress test with imaging, also called a myocardial perfusion scan, uses images to show blood flow to the heart muscle. The test uses a radioactive substance, which mixes with the blood and enters into the cells of the heart muscle. If the substance does not reach the heart, it means the arteries may be blocked or there may be damage to the heart.

A stress test with imaging is usually performed in conjunction with an exercise stress test, using either conventional exercise on a treadmill or using a medication such as a pharmacologic stress agent, which increases the blood flow like exercise.

Common uses

Physicians use a stress test with imaging to:

  • Evaluate the cause of chest pain
  • Measure the strength of your heart after a heart attack or surgery
  • Establish a baseline for patients who have cardiac risk factors such as high blood pressure, high cholesterol, or a family history of coronary artery disease
  • Determine how well your heart tolerates exercise and activity.

Safety

Prior to the test a physician or nurse will assess you to make sure it is safe for you to undergo this exam and answer any questions you may have. If you have coronary artery disease, it is possible that you could experience chest pain during the exercising or drug administered portion of the test. However, your heart will be monitored and if necessary, medication can be given for your chest pain.

Because the doses of radiotracer administered are small, these procedures result in minimal radiation exposure. Thus, the radiation risk is very low compared with the potential benefits. Allergic reactions to radiopharmaceuticals may occur but are extremely rare.

Women should always inform their physician or nuclear technologist if there is any possibility that they are pregnant or if they are breastfeeding their baby.

What should I expect BEFORE my stress test?

  • Medications: When your physician schedules your test, it is important to ask if you should take any of your medicines before the test.
  • Food and drink: You should not eat or drink anything three hours before your test. You should not smoke or have caffeine products (coffee, tea, soda, or chocolate) during the 24 hours prior to the test.
  • When to arrive: Please arrive at least 30 minutes before your scheduled appointment time.
  • What to wear: We recommend that you wear walking shoes and a comfortable two-piece outfit.
  • Intravenous preparation: An intravenous catheter will be inserted in your arm for intravenous contrast injection. If you have a known contrast allergy or had a reaction to contrast dye, please tell your physician and technologist prior to the exam.

What will I experience DURING my stress test?

  • Scanning: Your skin will be prepared and your chest hair may need to be shaved. Your skin will be cleaned with alcohol and then rubbed with an abrasive pad. Small pads called electrodes are placed on your upper body to monitor your heart rate.

    The heart is compared in two phases: At rest and then after exercise or medicine (pharmacologic stress agent) infusion. You will be given the first injection for the resting phase pictures of your heart. The second injection is given when you are exercising or when the medication is infusing, so we can see how well the heart does with increased work. Once you have the first injection you will have to wait approximately 30 minutes to go under a special camera for pictures. The pictures take approximately 15 minutes. You will be asked to lie very still while breathing normally.

    The next step is the stress portion of the test. You will be connected to a heart monitor and blood pressure cuff before, during, and after the exercise or medicine infusion. For the exercise method, you will be walking on a treadmill, which will gradually increase in speed and incline. You will exercise until you are very tired. For the medicine infusion, it will be administered slowly for five to six minutes. You may be asked to walk slowly on a flat treadmill or sit in a chair and do arm exercises to help prevent the side effects from the medicine.

    The second set of pictures will be done approximately 30 minutes after exercising or the medication infusion. Tell the nurse if you are having any discomfort at any time during the test.
  • Length of scan: Approximately two to three hours.

What should I expect AFTER my stress test?

  • Instructions: The nuclear tracer will be excreted naturally within 24 to 36 hours. If you have children under the age of three we recommend that close contact (hugging, cuddling) should be limited for 12 to 18 hours after your test. If you are breastfeeding we recommend you do not breastfeed for 24 hours. You may resume your regular diet, medications, and other activities. If you are flying within three days of the test please ask for a special form to inform airport staff about the test, as radiation detectors may pick up the nuclear tracer.
  • Exam results: All scans are read by a Mass General radiologist and cardiologist specialty trained in nuclear cardiology imaging.

    Rapid results are essential not only for your peace-of-mind, but also for your physician to begin planning your treatment immediately, if necessary. After the scan has been read the results are sent to your physician, who will discuss them with you.

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