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A nuclear stress test uses a small amount of radioactive material (tracer) and an imaging machine to create pictures showing the blood flow to your heart. The test measures blood flow while you are at rest and during activity, showing areas with poor blood flow or damage in your heart.

A nuclear stress test is one of several types of stress tests. The radiotracer used during a nuclear stress test helps your doctor determine your risk of a heart attack or other cardiac event if you have coronary artery disease. A nuclear stress test may be done after a regular exercise stress test to get more information about your heart, or it may be the first stress test used.

The test is done using a positron emission technology (PET) scanner or single photo emission computed tomography (SPECT) scanner. A nuclear stress test may also be called a myocardial perfusion imaging (MPI) study, cardiac PET study or cardiac SPECT study. Our office uses a SPECT scanner for this test.

Why it’s done

You may need a nuclear stress test if you have signs or symptoms of heart disease such as chest pain or shortness of breath. A nuclear stress test may also be used to guide your treatment if you’ve been diagnosed with a heart condition. Your doctor may recommend a nuclear stress test to:

Diagnose coronary artery disease. Your coronary arteries are the major blood vessels that supply your heart with blood, oxygen and nutrients. Coronary artery disease develops when these arteries become damaged or diseased — usually due to a buildup of deposits containing cholesterol and other substances (plaques).

If you have symptoms such as chest pain or shortness of breath, a nuclear stress test can help determine if you have coronary artery disease and how severe the condition is.

Determine a treatment plan. If you have coronary artery disease, a nuclear stress test can tell your doctor how well treatment is working. The test also helps your doctor develop the right treatment for you by determining how much exercise your heart can handle.

A pacemaker is an electrically-charged medical device. Your surgeon implants it under your skin to help manage irregular heartbeats called arrhythmias.

What is a pacemaker?

Modern pacemakers have two parts. One part, called the pulse generator, contains the battery and the electronics that control your heartbeat. The other part is one or more leads to send electrical signals to your heart. Leads are small wires that run from the pulse generator to your heart.
Pacemakers generally treat two types of arrhythmias:

• tachycardia, a heartbeat that’s too fast
• bradycardia, a heartbeat that’s too slow

Some people need a special type of pacemaker called a biventricular pacemaker, or bivent. You may need a bivent if you have severe heart failure. A bivent makes the two sides of the heart beat in sync. This is known as cardiac resynchronization therapy (CRT).

Why do I need a pacemaker?

You need a pacemaker if your heart is pumping too quickly or slowly. In either case, your body doesn’t get enough blood. This can cause:

• fatigue
• fainting or lightheadedness
• shortness of breath
• damage to vital organs
• eventual death

A pacemaker regulates your body’s electrical system, which controls your heart rhythm. With each heartbeat, an electrical impulse travels from the top of your heart to the bottom, signaling your heart’s muscles to contract. A pacemaker can also track and record your heartbeat. A record can help your doctor better understand your arrhythmia.

Not all pacemakers are permanent. Temporary pacemakers can control certain types of problems. You may need a temporary pacemaker after a heart attack or heart surgery. You may also need one if a medication overdose temporarily slowed your heart.

Your doctor or cardiologist will test you to see if you’re a good candidate for a pacemaker.

How is pacemaker surgery performed?

Implanting a pacemaker typically takes 1 to 2 hours. You’ll receive a sedative to relax you and a local anesthetic to numb the incision site. You’ll be awake during the procedure.

Your surgeon will make a small incision near your shoulder. They’ll guide a small wire through the incision into a major vein near your collarbone. Then the surgeon will lead the wire through your vein to your heart. An X-ray machine will help guide your surgeon through the process.

Using the wire, your surgeon will attach an electrode to your heart’s right ventricle. The ventricle is the lower chamber of the heart. The other end of the wire attaches to a pulse generator. This contains the battery and electrical circuits. Typically, your surgeon will implant the generator under your skin near your collarbone.

If you’re getting a biventricular pacemaker, your surgeon will attach a second lead to your heart’s right atrium. The atrium is the upper chamber of the heart.

At the end, your surgeon will close your incision with stitches.

What happens after pacemaker surgery?

You may go home that evening, or you could stay in the hospital overnight. Before you go home, your doctor will make sure the pacemaker is programmed properly for your heart’s needs. Your doctor can reprogram the device as needed at follow-up appointments.

Over the next month, you should avoid rigorous exercise and heavy lifting. You may also need to take over-the-counter medications for any discomfort. Ask your doctors what pain relievers are safest for you.

Every few months, you’ll hook your pacemaker up to a phone line using special equipment provided by your doctor. It allows your doctor to receive information from your pacemaker without the need for an office visit.

Modern pacemakers are not as sensitive to electrical devices as the old ones, but certain devices could cause interference with your pacemaker. For example, you should avoid:

• keeping a cell phone or MP3 player in the pocket over your pacemaker
• standing for too long near certain appliances, such as microwaves
• long exposures to metal detectors
• high-voltage transformers

Your doctor will give you more detailed instructions about how to minimize your risks.

Angioplasty with stent placement is a minimally invasive procedure used to open narrow or blocked arteries. This procedure is used in different parts of your body, depending on the location of the affected artery. It requires only a small incision.

Angioplasty is a medical procedure in which your surgeon uses a tiny balloon to widen an artery. A stent is a tiny mesh tube that’s inserted into your artery and left there to prevent it from closing. Your doctor may recommend taking aspirin or antiplatelet drugs, such as clopidogrel (Plavix), to prevent clotting around the stent, or they may prescribe medications to help lower your cholesterol.

Why Angioplasty and Stent Placement Is Done

When your cholesterol levels are high, a fatty substance known as plaque can attach to the walls of your arteries. This is called atherosclerosis. As plaque accumulates on the inside of your arteries, your arteries can narrow. This reduces the space available for blood to flow.

Plaque can accumulate anywhere in your body, including the arteries in your arms and legs. These arteries and other arteries farthest from your heart are known as peripheral arteries.

Angioplasty and stent placement are treatment options for peripheral artery disease (PAD). This common condition involves the narrowing of arteries in your limbs.

The symptoms of PAD include:

• a cold feeling in your legs
• color changes in your legs
• numbness in your legs
• cramping in your legs after activity
• erectile dysfunction in men
• pain that’s relieved with movement
• soreness in your toes

If medication and other treatments don’t help your PAD, your doctor may opt for angioplasty and stent placement.

An angioplasty is also used as an emergency procedure if you’re having a heart attack or stroke.

The Risks of the Procedure

Any surgical procedure carries risks. The risks associated with angioplasty and stents include:

• allergic reactions to medication or dye
• breathing problems
• bleeding
• blood clots
• infection
• kidney damage
• re-narrowing of your artery, or restenosis
• rupture of your artery

The risks associated with angioplasty are small, but they can be serious. Your doctor will help you evaluate the benefits and risks of the procedure. In some cases, your doctor may prescribe anticlotting medications, such as aspirin, for up to a year after your procedure.

Outlook and Prevention

While angioplasty with stent placement addresses an individual blockage, it doesn’t fix the underlying cause of the blockage. To prevent further blockages and reduce your risk of other medical conditions, you may have to make certain lifestyle changes, such as:

• eating a heart-healthy diet by limiting your intake of saturated fats, sodium, and processed foods
• getting regular exercise
• quitting smoking if you smoke because it increases your risk of PAD
• managing stress
• taking cholesterol-reducing medications if they’re prescribed by your doctor

Your doctor may also recommend the long-term use of anti-clotting drugs, such as aspirin, after your procedure. Don’t stop taking these medications without talking to your doctor first.