Nuclear Cardiology: Nuclear Cardiology:

Chapter 5 / Stress Procedures 435Stress ProceduresIn a well-run facility details of all procedures and policiesare described in written protocols to ensure standardizationand consistency of daily operations. Since no imaging facilityoperates under identical circumstances, protocols must bemodified to meet specific needs. In order to meet standardsfor accreditation by the ICANL, for example, well-detailed“laboratory-specific protocols” play an important role (SeeChapter 18 and on line: www.icanl.org). This chapterdiscusses:• Indications and methodology• Physical exercise testing• Pharmacological stress testingPURPOSE OF STRESS PROCEDURESMost stress procedures are performed in patients with symptoms ofsuspected or known ischemic heart disease . Patients must have stablesymptoms or have been stabilized by therapy. The purpose of stressprocedures is to provoke symptoms in a controlled and safe environmentand thus aid in establishing the etiology of symptoms. Stress proceduresmust be performed under direct supervision by a physician.IndicationsAppropriate clinical indications for stress testing are discussed in the“AHA/ACC 2002 Guideline Update for Exercise Testing,” see:www.acc.org/clinical/guidelines/exercise/exercise.pdf. In brief theyinclude:1. Diagnosis of obstructive coronary artery disease.2. Risk assessment and prognosis in patients with symptoms or knowncoronary artery disease.From: Contemporary Cardiology: Nuclear Cardiology, The BasicsF. J. Th. Wackers, W. Bruni, and B. L. Zaret © Humana Press Inc., Totowa, NJ43