Pharmacologic stress myocardial perfusion imaging.
Pharmacologic stress agents (dipyridamole, adenosine and dobutamine) allow virtually all patients to be safely assessed for ischemic heart disease. These agents have mild but significant side effects, mandating a thorough knowledge of indications, contraindications, side effects and management before their use. Adjunctive exercise improves image quality in vasodilator pharmacologic myocardial perfusion imaging. Diabetics, especially women, have a much higher cardiac event rate than nondiabetics for an equal amount of ischemia. They also have a higher incidence of asymptomatic ischemia. There is growing support for screening with myocardial perfusion imaging (MPI) for asymptomatic ischemia in diabetics. The ability of MPI to identify hypocontractile but viable myocardium, thus predicting improvement in myocardial function after revascularization, is one of the most powerful uses of the modality. Vasodilator MPI should be used as the initial test in patients with left bundle branch block or paced ventricular rhythm, even if they are able to exercise.
Patel
Rakesh N
RN
Department of Medicine and the Division of Cardiology, Medical College of Georgia, Augusta, GA, USA.
Arteaga
Roque B
RB
Mandawat
Mahendra K
MK
Thornton
John W
JW
Robinson
Vincent J B
VJ
D003326:Coronary Circulation / Q000502:physiology*; D048909:Diabetes Complications; D003952:Diagnostic Imaging; D005080:Exercise Test / Q000379:methods*; D006801:Humans; D009200:Myocardial Contraction / Q000502:physiology; D017202:Myocardial Ischemia / Q000175:diagnosis; D014665:Vasodilator Agents
D014665:Vasodilator Agents