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What are the risk of having a nuclear stress test while in atrial fibrillation?
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An_252167 posted:
Risk of having a nuclear stress test with atrial fibrillation
My husband is in Atrial Fib and is on coumadin he was to have a cardiovversion after 4 weeks of INR of 2-3 but his cardiologist was out of town so it wasn't done and now he has to wait another 4 weeks. In the meantime his doctor has ordered a nuclear stress test. Should the stress test be postponed until after the cardioversion. What are the risks if he has the stress test with his heart out of rhythm?
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cardiostarusa1 responded:
Hi:

Possible risks, as well as any concerns or worries, should be discussed with his doctor.

In general-only here, as reported, contraindications for nuclear stress tests includes an uncontrolled arrhythmia (irregular heartbeat) which may have significant hemodynamic responses (compromise blood flow), such as ventricular tachycardia (VT).

Additionally, if/when the patient is unable to exercise and a chemical/drug stressor agent will be administered (pharmacologic stress) instead, certain ones, such as dobutamine, may need to be avoided, which may/can trigger off or exacerbate an arrhythmia such as a-fib or sinus tachycardia.

The Basics

The two main concerns regarding a nuclear stress test involves an actual narrowing or scarring, that is, the findings of reversible (ischemia) or non-reversible (fixed, permanent, scar tissue) perfusion (blood flow) defects.

After stress myocardial perfusion imaging (stress MPI), the patient's cardiologist may take some time to study the results of the scan before discussing the findings.

One can typically expect one of the following four results -

1:

No perfusion defect after exercise or at rest

The heart muscle and blood flow to the heart muscle appear to be normal.

2:

Perfusion defect after exercise, BUT NOT at rest (REVERSIBLE** defect)

There is some degree of blockage in a coronary artery that interferes with the blood flow to the heart muscle. In someone with significant heart disease, when the heart works hard, it does not get the blood supply and oxygen that it needs (a supply 'n demand mismatch).

At rest, however, the blood adequately reaches these areas or regions, e.g., ANTERIOR/ANTERO (front wall), POSTERIOR (back wall), INFERIOR (lower area/lower wall area), SEPTAL/SEPTUM (dividing wall) APICAL/APEX (bottom tip of the heart) and LATERAL (side wall).

The heart muscle has living cells/tissue in these areas. This indicates that clearing the blockage in the affected artery will be of benefit.

3:

Perfusion defect AFTER exercise AND at rest (fixed defect)

There is one or more totally blocked coronary arteries and one has had damage done to the heart muscle because of a heart attack.

There is an area/areas of the heart muscle that has become scar tissue (scarring, scarred) because of the heart attack.

This area would not be able to make functional use of any oxygen even if blood flow to that area of the heart were completely restored.

4:

Combined reversible and fixed defects

It is common for individuals with coronary artery disease to have different degrees of blockages in different arteries.

A heart attack has left a fixed defect in one area of the heart, but there is a reversible defect in another area of the heart due to a less severe blockage.

HeartSite

Isotope - Nuclear Stress Test

SEE actual rest/stress images.

http://www.heartsite.com/html/isotope_stress.html

Coronary artery anatomy

Starting with the left anterior descending (LAD). The most critical, next to the ultra-critical left main (LM).

http://www.heartsite.com/html/lad.html

Best of luck to your husband and you down the road of life.

Take care,

CardioStar*

WebMD member (since 8/99)

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Quote!

"Be a questioning patient. TALK to your DOCTOR and ASK QUESTIONS. Studies show that patients who ask the most questions, and are most assertive, get the best results. Be vigilant and speak up!"

- Charles Inlander, People's Medical Society

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WebMD/WebMD forums does not provide medical advice, diagnosis or treatment.


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