What's a nuclear stress test like? Is it safe?

Posted by Gail, Alumni Mentor @baxtersmom, May 17, 2017

I had an EKG and my doctor dictated that it showed the following: Sinus Rhythm 79 PVC Inferior Lateral ST Depression. My doctor has ordered a nuclear medicine stress test because I have some back problems and I was concerned about doing the treadmill stress test. I guess I have two questions/concerns and wondered if anyone might shed some light on either of them. First, what does this dictation that my doctor put in my record mean about my EKG? I have had a benign PVC all of my life but don't know if this is the same thing. I had been feeling like my chest was heavy and very tired, a little breathless sometimes which is why I went in to the cardiologist. Second, has anyone had a nuclear medicine stress test? I am concerned about the side effects and not being able to control them. I read about some of them and saw that the FDA had issued a warning about risks with nuclear medicine stress tests. Then I saw on the Mayo Clinic site that the nuclear medicine test may be more accurate and if the regular treadmill one isn't conclusive, I might end up having to do the nuclear one anyway. It was an ECO stress test I had many years ago when the benign PVCs were discovered. I am really afraid of doing the nuclear test. Please guide me if you can.

Interested in more discussions like this? Go to the Heart Rhythm Conditions group.

@bummed

had major motorcycle accident 8 13 2017, imaging at hospital then listed heart as normal. Va echo sept 13 2020 shows 4.8cm ATA, had a 2 minute discussion not to exercise or lift more than 25 lbs. I when to the VA for a NCST. I asked if I'm not supposed to exert and this stress test dilates and slows the heart and in constant Afib ( misses a beat every 4 to 5 beats ) they could would not say it's safe…
It appears to me the Nuclear doctor was not working with Cardiology. I understand the normal risks but don't want to add more thanks

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The way it works for me is that my cardiologist orders the test and the radiologist follows those orders. If you have been prescribed a chemical stress test by your cardio and the radiologist doesn't think that is safe, I think you need to go back to your cardiologist to discuss.

I have always understood that AFib is a (very) rapid heartbeat, not missed beats. I think missed beats are not as serious as AFib but this is another discussion to have with your cardio.

And in the meantime, I would follow direction to not exercise or lift even 25 lbs.

This is a learning process for all of us and I always make a list of issues I don't understand or questions I have.

I wish you good luck with all of this. You will feel better once you have more details.

Donna

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@degarden_girl

The way it works for me is that my cardiologist orders the test and the radiologist follows those orders. If you have been prescribed a chemical stress test by your cardio and the radiologist doesn't think that is safe, I think you need to go back to your cardiologist to discuss.

I have always understood that AFib is a (very) rapid heartbeat, not missed beats. I think missed beats are not as serious as AFib but this is another discussion to have with your cardio.

And in the meantime, I would follow direction to not exercise or lift even 25 lbs.

This is a learning process for all of us and I always make a list of issues I don't understand or questions I have.

I wish you good luck with all of this. You will feel better once you have more details.

Donna

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has been referred to irregular irregular Atrial fibrillation for the past 25 years, Had 2 unsuccessful conversion attempts.
Also have central mixed apnea, and use CPAP and a bit of traumatic brain injury with a lot of fractured body parts.
I was asking about what part of Nuclear Chemical Stress test isn't Stress,,,lol thanks

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@degarden_girl

The way it works for me is that my cardiologist orders the test and the radiologist follows those orders. If you have been prescribed a chemical stress test by your cardio and the radiologist doesn't think that is safe, I think you need to go back to your cardiologist to discuss.

I have always understood that AFib is a (very) rapid heartbeat, not missed beats. I think missed beats are not as serious as AFib but this is another discussion to have with your cardio.

And in the meantime, I would follow direction to not exercise or lift even 25 lbs.

This is a learning process for all of us and I always make a list of issues I don't understand or questions I have.

I wish you good luck with all of this. You will feel better once you have more details.

Donna

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I have " chaotic irregular irregular" a fib and miss a beat about every 4 to 5 beats. Been that way for 20 years.
CT scans show an ascending aortic aneurism at 4.8 with the root at 5.1.
So I am concerned about a stress test being safe…

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I am new to Mayo Connect, posting because I am concerned about a nuclear stress test scheduled for 10 days from now. After wearing a heart recording device I was told the results were "crystal clear" that I have AFib and atrial flutter. Cardiologist told me I needed a Lexiscan nuclear stress test. I asked her if the heart recorder showed any episodes of abnormally low heart rate, and she said no. I know I've had episodes of bradycardia as well as tachycardia. I have a pulse ox monitor for COPD. When I feel faint or out of breath I use this and have seen a number of instances where my oxygen level was fine but heart rate was in 30's and 40's. Yesterday after exertion I felt unwell and pulse rate was between 29-44 for several minutes until I laid down.

I am wondering if the stress test is appropriate when it's not yet been determined whether my problem is one related to electrical activity in the heart? I had the feeling the doctor was not tuned in to what I was trying to say about having had bradycardia symptoms as well. I'd like to hear if anyone else has been through this scenario.

Bay20740

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I don't have the conditions you note, so this might not be reassuring, but did have a nuclear stress test with no difficulties, during or thereafter.

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I have one tomorrow.Nervous as someone told me a scary story about someone dying after one .Of course know no details.I might have had one. Years ago. I gave AFib for years.fast.slow beats.pauses.on meds for years..recently had pounding heart.went to er .AFib but okey.will let u know of my experience.

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I have bradycardia (and afib with super high rates) and have had three nuclear stress tests with no problem.

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@bettysamny

I have one tomorrow.Nervous as someone told me a scary story about someone dying after one .Of course know no details.I might have had one. Years ago. I gave AFib for years.fast.slow beats.pauses.on meds for years..recently had pounding heart.went to er .AFib but okey.will let u know of my experience.

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Good morning, @bettysamny and @bay20740 Thought I’d pop into this conversation about having a nuclear stress test. I hope I can reassure you that it sounds much more intense and frightening than reality.

There will always be anecdotal stories by well meaning people, especially on the internet, of rare events that can happen. I’ve had several of these nuclear stress tests over the past several years, under some extreme health conditions, and breezed right through them.

In a large nutshell, you’ll be having some images of your heart and blood vessels taken at rest and after exercise. The radiotracer allows for a comparison of how your blood flows during those periods.

You’ll have a small IV line inserted in your arm. Mine is always just on the top of my hand and is painless.
Once that’s done you’ll have the radiotracer injected. It can feel a little cold but that’s all.
Next you’ll have some images of your heart taken by lying on a table. The camera moves over the top of you. This is not an MRI and you’re not enclosed. Though the camera is large and does come close to your chest. I asked the technician to talk with me during this so that I felt relaxed. I also closed my eyes the first time and kept focused on breathing. After that it was easy peasy.

After those first images, you’ll have some little EKG wires attached to your chest to monitor your heart. You might also be asked to do some breathing exercises, depending on the test.
Next, you’ll be on a treadmill to increase your heart rate. If you’re not able to walk on the treadmill, then there is a drug that’s given to increase your heart rate without exercise.
I’ve had it both ways and again, my anxiety was totally unfounded.
Once your heart rate is up, you’ll have another injection of the radiotracer and then have the final series of images. The first images taken with the radiotracer, allows the radiologist to see your circulatory system at rest. The second images show areas where your blood isn’t flowing freely during exertion and easily compared.
Then you get dressed and off you go! Drink plenty of fluids to help your body flush out the radiotracer.

I’m posting a link to the Mayo Clinic website that explains about the procedure. I’d like you to take your time and read through the entire article. It gives a great explanation as to why the test is done and what to expect during the procedure.
https://www.mayoclinic.org/tests-procedures/nuclear-stress-test/about/pac-20385231
Also, you are never alone! There are technicians and a nurse present at all times who are fully capable of responding ‘in a heartbeat’…pun in tended. ☺️
Does this help a little to allay your fears? And will you both let me know how you faired after the tests?

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I will. I wasn't afraid but hearing that story upset me I spoke with nurse and she was reassuring.

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@loribmt

Good morning, @bettysamny and @bay20740 Thought I’d pop into this conversation about having a nuclear stress test. I hope I can reassure you that it sounds much more intense and frightening than reality.

There will always be anecdotal stories by well meaning people, especially on the internet, of rare events that can happen. I’ve had several of these nuclear stress tests over the past several years, under some extreme health conditions, and breezed right through them.

In a large nutshell, you’ll be having some images of your heart and blood vessels taken at rest and after exercise. The radiotracer allows for a comparison of how your blood flows during those periods.

You’ll have a small IV line inserted in your arm. Mine is always just on the top of my hand and is painless.
Once that’s done you’ll have the radiotracer injected. It can feel a little cold but that’s all.
Next you’ll have some images of your heart taken by lying on a table. The camera moves over the top of you. This is not an MRI and you’re not enclosed. Though the camera is large and does come close to your chest. I asked the technician to talk with me during this so that I felt relaxed. I also closed my eyes the first time and kept focused on breathing. After that it was easy peasy.

After those first images, you’ll have some little EKG wires attached to your chest to monitor your heart. You might also be asked to do some breathing exercises, depending on the test.
Next, you’ll be on a treadmill to increase your heart rate. If you’re not able to walk on the treadmill, then there is a drug that’s given to increase your heart rate without exercise.
I’ve had it both ways and again, my anxiety was totally unfounded.
Once your heart rate is up, you’ll have another injection of the radiotracer and then have the final series of images. The first images taken with the radiotracer, allows the radiologist to see your circulatory system at rest. The second images show areas where your blood isn’t flowing freely during exertion and easily compared.
Then you get dressed and off you go! Drink plenty of fluids to help your body flush out the radiotracer.

I’m posting a link to the Mayo Clinic website that explains about the procedure. I’d like you to take your time and read through the entire article. It gives a great explanation as to why the test is done and what to expect during the procedure.
https://www.mayoclinic.org/tests-procedures/nuclear-stress-test/about/pac-20385231
Also, you are never alone! There are technicians and a nurse present at all times who are fully capable of responding ‘in a heartbeat’…pun in tended. ☺️
Does this help a little to allay your fears? And will you both let me know how you faired after the tests?

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Lori, thank you for your post. My biggest concern about the scan comes from this note in the Lexiscan prescribing information: "Do not administer LEXISCAN to patients with:
• Second- or third-degree AV block, or
• sinus node dysfunction
unless these patients have a functioning artificial pacemaker [see Warnings and Precautions (5.2)]"

I don't know if I have sinus node dysfunction or not. My doctor told me this was something that would be determined by the scan. But maybe there is some other test that should be performed first?

I should mention that I live in an area classified as "medically under-served." The cardiologists' reception room is almost always standing room only. I think the doctors are doing the best they can with an overwhelming patient load. Still, it is unsettling to be told, "Call if you have any questions," when voice mail may or may not produce a response.

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