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Dear Patient, It is very important to follow these instructions to ensure high quality results from your nuclear cardiology stress test: 1. Please be on time for your appointment. 2. Shower or bathe the day of the test. Do not apply lotion and or powder to your chest. 3. Wear loose fitting slacks or shorts, a shirt or blouse with buttons in front, sneakers or walking shoes. No metal buttons or snaps on shirt or blouse. 4. Please do not eat or smoke at least two (2) hours prior to the test. Do not drink regular or decaffeinated coffee/tea or caffeinated beverages twelve hours (12) hours prior to the procedure.
The same holds true for any medications containing caffeine. Caffeine will prevent the drug
used for the stress test from being fully effective.
* Patients scheduled later in the morning (after 10:00 AM), or in the afternoon may have a
light breakfast (i.e. cereal & orange juice).

5. Bring a list of current medications and doses. Please ask your physician before your scheduled test day if you need to discontinue any medications the day of the study. 6. Any medications that are Dipyridamole (Persantine), Adenosine or Theophylline based should not be taken at least 48 hours prior to the study. Please check with your physician. 7. For safety reasons, Viagra, Levitra, and Cialis medications must be discontinued for 72 hours 8. We suggest that you bring a snack (i.e. sandwich, fruit, juice or water). You will have an opportunity to eat at some point during the test. 9. * If you are diabetic, contact your doctor for instructions regarding diet and medications before
your scheduled test day. If possible, request an early morning test appointment in order to accommodate your routine meal schedule. 10. Women should always inform their physician or the technologist if there is any possibility that they are pregnant or if they are breastfeeding.
Testing Procedure:

1. A Digirad technical staff member will explain the test to you, ask you some questions, and have 2. An intravenous (IV) line will be started in your arm/hand by the Digirad clinical team. A radioactive isotope will then be administered through the IV line. Upon localization, the isotope allows images of your heart to be obtained. 3. You will need to wait 20-60 minutes after the injection depending on the agent used, and then pictures will be taken. These take approximately 10-15 minutes. 4. Next, you will either walk on the treadmill or be made comfortable and injected with a stress medication. During this time, your EKG and blood pressure are monitored closely. During the stress exam you will receive the second injection of the radioactive isotope. 5. Following the stress portion of the test, you will be a monitored (your blood pressure and EKG are watched closely) until you heart returns to its normal resting state. 6. After waiting for 20-60 minutes, additional images of the heart will be taken. These images take approximately 10 minutes. The test is then complete. The average time is 3-4 hours, but the total test time can vary with each physician’s office. If you wish, check with your physician’s office regarding their scheduling routine.
What to expect:
An IV will be started in your arm and through the IV and you will be given a total of two (2) dosages of a
radioisotope. The isotope is a material that contains no drugs or dyes, just a low level of radiation, which
is enough to take pictures of the blood flow through the major vessels of your heart. Because the doses of
the isotope are small, diagnostic nuclear medicine procedures result in low radiation exposure, acceptable
for diagnostic exams. Thus, the radiation risk is very low compared with the potential benefits. No special
pre-cautions are needed. Reactions to the isotope have not been reported.

The first dose of the isotope is used to take pictures of the blood flow through the heart while at rest. The
second dose of the isotope allows pictures of the blood flow through the heart after “exercise.”
Treadmill studies:
The second dose of isotope will be administered while you are walking on the treadmill; you will be
required to walk one (1) additional minute after the dose is administered. After monitoring and recovery,
you will then have a short break (20-60 minutes) before the last set of images are recorded. You may eat
and drink during this time. The exam will be complete after the last set of images has been recorded.
Pharmacologic Studies:

The second dose of isotope will be administered under one of the following protocols:
a) Two (2) minutes following the Persantine medication administration. b) Halfway through the Adenosine medication administration. c) Fifteen seconds after Lexiscan medication administration. d) One (1) minute into the last stage of the Dobutamine medication administration.
You will then have a break (45-60) minutes before the last set of images are recorded. You may eat and
drink during this time. The exam will be complete after the last set of images has been recorded.
PRESCRIPTION MEDICATIONS CONTAINING THEOPHYLLINE
(Do not take 48 hours prior to study)

Theovent Long-Acting
Aggrenox: 200 mg. Persantine; 25 mg. ASA
***Please Also Discontinue Dipyridamole (Persantine)***
COMMONLY-PRESCRIBED DRUGS CONTAINING CAFFEINE
(Do not take 12 hours prior to study)


OVER-THE-COUNTER DRUGS CONTAINING CAFFEINE

Anacin

COMMONLY-USED BEVERAGES AND FOODS CONTAINING CAFFEINE
(Do not take 12 hours prior to study)

Coffee

Brewed Drip Coffee

Tea

Brewed Commercial Tea

Food

Cocoa

Soft Drinks

Tab
This list is not intended to be all-inclusive. If you have any questions, please call
your attending Physician for advice before your scheduled test date.


Reference:
American Society of Nuclear Cardiology
Imaging Guidelines for Nuclear Cardiology Procedures, 2006
DISSPEC022 Rev B

Source: http://brandondocs.com/wp-content/uploads/2011/12/BAPC-NUKE-INS.pdf

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DEPRESSION AND ANXIETY 26 : 711–717 (2009)CHILDHOOD NEGLECT AND ABUSE AS PREDICTORS OFANTIDEPRESSANT RESPONSE IN ADULT DEPRESSIONJeanette M. Johnstone, M.A.,1Ã Suzanne E. Luty, M.B. Ch.B. Ph.D. F.R.A.N.Z.C.P.,1Janet D. Carter, Ph.D. Dip. Clin. Psych. M.N.Z.C.C.P.,2 Roger T. Mulder, M.B. Ch.B. Ph.D. F.R.A.N.Z.C.P.,1Christopher M.A. Frampton, Ph.D.,1 and Peter R. Joyce, M.D. Ph.D. D.Sc. F.R.

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