Harvard Heart Letter

Ask the doctor: Are there noninvasive alternatives to a nuclear stress test?

Q. After I had an abnormal electrocardiogram, my doctor wants me to have a nuclear stress test to check my arteries for any blockages. (I also have a left side bundle block.) What noninvasive test would give as much information (or almost as much) as a nuclear stress test? I have had many scans, for this and that, so I would like to limit my exposure to radiation if possible.

A. There are a number of options to test for coronary artery blockages. The gold standard is coronary angiography. But since it is invasive, requiring that a catheter be inserted into the heart, imaging tests are often used first to see if a coronary angiogram is needed.

The most common imaging tests are the nuclear stress test and the stress echocardiogram. The nuclear stress test uses a radioisotope to make blood flowing through the coronary arteries appear on a scanner, so it exposes you to radiation. A stress echocardiogram uses ultrasound to "see" the motion of the heart. When blood flow through the coronary arteries is compromised, part of the heart wall moves differently — a change that an experienced echocardiographer can detect. A stress echocardiogram does not use ionizing radiation; the small amount of energy delivered by medical ultrasound has never been shown to harm tissues.

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