II. Indications

  1. Cardiac Screening in patients unable to Exercise 5 Mets
  2. Intermediate pretest risk of CAD

III. Tests

  1. Dobutamine Echocardiogram
    1. No Beta Blockers for 24 hours before test
    2. Avoid if very large body habitus (poor echo window)
      1. Definity or optison contrast can be used to increase accuracy
  2. Myocardial Perfusion Imaging with Adenosine (or Regadenoson/Lexiscan)
    1. Avoid in severe COPD, Asthma, Carotid Stenosis
    2. No nitrates on day of test
    3. No Methylxanthines (e.g. Caffeine) for 24 hours prior
  3. Myocardial Perfusion Imaging with Dipyridamole
    1. Uses Dipyridamole (Persantine) instead of Adenosine
    2. Determine Cardiac Risk pre-major non-cardiac surgery
    3. May also help with prognosis after major surgery

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