Myocardial Perfusion With Or Without Exercise Page 2
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1
2
3P
-P
I
:
RE
ROCEDURE
NSTRUCTIONS FOR
PLEASE READ BOTH SIDES OF INSTRUCTION FORM
Myocardial Perfusion Scan Treadmill Stress Test
Myocardial Perfusion Scan Adenosine or LexiScan Stress Test
P
N
:
D
: ___________________
___________________________________
ATIENT
AME
OCTOR
D
:
T
:
___________________________________________
__________________________
ATE
IME
San Diego Cardiovascular Assoc.
Other Appts:
_____________ ________________
320 Santa Fe Dr. Ste #204
Encinitas, Ca. 92024 (760)944-7300
I
,
48
.
F YOU NEED TO CANCEL
IT IS VERY IMPORTANT TO DO SO
HOURS IN ADVANCE
D
:
IRECTIONS
Do not have any caffeinated or decaffeinated coffee, tea, chocolate, energy drinks, etc 24hrs
prior to test.
You should have nothing to eat three hours before your test. (However, liquids such as
water and juice are okay.)
If you are having an afternoon test, please eat a good breakfast. You may take your
regular medications with water or juice.
Wear loose, comfortable clothing and tennis shoes if your test includes a treadmill.
Do not wear anything with metal around your chest area. This includes necklaces, metal
buttons or zippers.
E
P
:
XPLANATION OF
ROCEDURE
This test will take 3 to 4 hours and is done in two parts. An IV is inserted into a vein in your arm or
hand and the radioisotope will be injected. The technician will take a set of preliminary pictures called
resting images then you will have the exercise portion of your test.
If you are having an exercise treadmill, you will walk on the treadmill until your heart rate reaches
it’s maximum level which is called your target heart rate. The doctor will monitor your heart rate and
supervise the treadmill. After your target heart rate is reached or you are fatigued, a second injection
of radioisotope will be given while you are walking on the treadmill. After the treadmill, you will drink
some cold water and a second set of images will be taken.
If you are having a chemical stress test, instead of walking on the treadmill, adenosine or lexiscan
will be injected into the IV to dilate the arteries much like what would happen during exercise. The
doctor will monitor and supervise the test. After the injection, a second set of images will be taken.
Pre-Procedure Adenosine-Cardiolite Instruction Sheet – 11-7-2012
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