What you should know about nuclear stress tests

According to Dr. Eric Bricker’s article on Compass Navigating Heathcare Blog, “Stress tests are extremely controversial within the field of cardiology. Many cardiologists think that far too many are ordered. Similarly, many believe that when they are ordered, the chemical nuclear tests are used more often than they should be—when other types of stress tests could have been better choices.”

What is a Nuclear Stress Test?

The nuclear stress test is also known as the thallium stress test, a myocardial perfusion scan, or a radionuclide test. This testing procedure uses a radioactive substance to determine the health of the heart.

“In a chemical stress test, the patient receives medications that either speed up the heart rate or dilate the arteries. The body responds in a similar way it would do to exercise,” according to an article in Medical News Today. www.medicalnewstoday.com/.

A nuclear stress test is used when patients cannot exercise—for example if a person has knee or leg problems. According to an article on the Mayo Clinic website, “If you aren’t able to exercise, you’ll receive a drug through an IV that mimics exercise by increasing blood flow to the heart. A nuclear stress test can take two or more hours, depending on the radioactive material and imaging tests used.” www.mayoclinic.org/.

Risks of Nuclear Stress Tests

In 2013, the U.S. Food and Drug Administration (FDA) warned health care professionals of the rare, but serious risk of heart attack and death with the use of the cardiac nuclear stress test agents Lexican (regadenoson) and Adenoscan (adenosine). The FDA approved changes to the drug labels to reflect this information.

“Also, some of the medicines used for pharmacological stress tests can cause wheezing, shortness of breath, and other asthma-like symptoms. Sometimes these symptoms are severe and require treatment,” according to the National Heart, Lung, and Blood Institute. www.nhlbi.nih.gov/.

According to a 2017 article in the journal Inside Radiology, “The overall risk of sustaining a heart attack from a stress test is approximately 2 to 3 in 10,000…There is a very small risk from the ionizing radiation emitted by the radiopharmaceutical.” www.insideradiology.com.au/.

But what if your loved one was in the 2 or 3 in 10,000 patients that died from a heart attack during or after a nuclear stress test? Consumers of medical services need to be aware of information not provided by general practitioners or cardiologists. Ask about the benefits vs. risks. Seek out a second opinion if your questions are not answered.

Questions to Ask Your Doctor

The FDA recommends that patients talk to their health professionals with concerns about nuclear stress tests or any nuclear stress test agents.

Why do I need this test? Why are you doing this test rather than a different one without radiation? Do you think the small possible risk of cancer related to X-rays is justified compared to my condition and my risk of having heart trouble? What if I get chest pain or shortness of breath during the test? Will I need to have more tests after this? www.nhlbi.nih.gov/.