after intravenous administration of technetium followed by exercise (or pharmacologic stress) 1 to 3 hours later. Stress images are obtained 10 minutes after injecting technetium, which is given ~1 minute before completion of peak exercise. Comparison of the rest and stress images permit differentiation of fixed versus transient perfusion abnormalities. Pharmacologic Stress Test Unable to undergo exercise testing o Dobutamine stress echocardiography Elicits wall motion abnormalities by increasing HR, therefore MVO 2 Atropine given if adequate heart rate or other endpoints have not been reached o Adenosine (vasodialator) used to assess coronary perfusion in conjunction with a nuclear imaging agent Patients unable to undergo exercise stress testing for reasons such as de- conditioning, peripheral vascular disease, orthopedic disabilities, neurologic disease, and concomitant illness may be evaluated by pharmacologic stress testing. The two most commonly used pharmacologic tests are: o Dobutamine stress echocardiography o Adenosine stress with nuclear imagining Some protocols include light exercise in combination with pharmacologic infusion. Dobutamine stress echocardiography 6
Cardiac Computed Tomography (CT) Noninvasive technique Detection of coronary artery calcified plaque Calcium scores alone not diagnostic Computed Tomography in the Assessment of Coronary Artery Disease o Coronary CT angiography is an emerging noninvasive technique that can evaluate the coronary artery lumen and wall, and can be used to detect the presence of obstructive stenoses. o It is a highly sensitive method for the detection of coronary artery calcified plaque. o
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