Stress Myocardial Perfusion Scan

What is a stress myocardial perfusion scan?

Myocardial perfusion is an imaging test. It's also called a nuclear stress test. It is done to show how well blood flows through the heart muscle. It also shows how well the heart muscle is pumping. For example, after a heart attack, it may be done to find areas of damaged heart muscle. This test may be done during rest and while you exercise.





Why might I need a stress myocardial perfusion scan?

Your doctor may order a stress myocardial perfusion scan for:

  • To diagnose coronary artery disease (CAD), which is the narrowing of the coronary arteries


  • After a heart attack (myocardial infarction, or MI) to assess heart muscle damage
  • To assess blood flow to areas of the heart muscle after coronary artery bypass surgery, angioplasty, or stent placement.
There may be other reasons for your healthcare provider to recommend a stress myocardial perfusion scan.


What are the risks of a stress myocardial perfusion scan?

Risks of the scan may include:

  • The exercise part of the test may lead to rare instances of abnormal heart rhythms, chest pain, or heart attack due to the stress on the heart caused by the exercise.
  • The needle used to put in the IV may cause some pain.
  • If your heart is stressed using medicine, you may feel anxious, dizzy, nauseous, shaky, or short of breath or chest pain for a brief period.



Make a list of questions you have about the procedure. Be sure to discuss these questions with your healthcare provider before the procedure. Bring a family member or friend to the appointment to help you remember your questions and concerns.


  • Use of medicines containing theophylline
  • Caffeine intake within 48 hours of the procedure
  • Certain heart medicines, such as those that slow the heart rate


How do I prepare for a stress myocardial perfusion scan?





  • If you are scheduled for a pharmacologic myocardial perfusion scan, you will need to avoid taking any medications containing theophylline or caffeine. Coffee, even decaffeinated, is not allowed, as it contains some caffeine. Medications for asthma may contain theophylline. If you have asthma, inform your healthcare provider. Theophylline medications should be stopped 48 hours prior to the test.
  • Medications that contain caffeine and all food and drink containing caffeine should be held for 48 hours, too.
  • Tell your healthcare provider if you have a pacemaker or implantable cardioverter defibrillator.
  • For an exercise scan, plan to wear loose, comfortable clothing, as well as comfortable walking shoes.

What happens during a stress myocardial perfusion scan?

You may have a stress myocardial perfusion scan on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your healthcare providers practice.

Generally, a stress myocardial perfusion scan follows this process:


Exercise myocardial perfusion scan:

  1. You will exercise on a treadmill. The intensity of the exercise will be gradually increased by increasing the speed of the treadmill.
  2. Your heart rate and blood pressure will be monitored. Once you have reached your maximal exercise point (determined by the healthcare provider based on your heart rate and age), the radioactive tracer will be injected into your IV line.
  3. After the tracer has been injected, you will continue to exercise for several minutes.
  4. You will then be placed into the heart scanner so images can be taken.

Pharmacologic myocardial perfusion scan:

  1. You will not exercise on a treadmill. Instead, you will lie on the table in the heart scanner while a medicine is injected into your IV.
  2. Your heart rate and blood pressure will be monitored.
  3. The tracer will be injected into your IV line.

Procedure completion, both methods:

  1. If you have any symptoms such as dizziness, chest pain, extreme shortness of breath, or severe fatigue at any point during the procedure, let the healthcare provider or technologist know.
  2. You will lie flat on a table while the images of your heart are taken. About 10 to 60 minutes (depending on the type of tracer used) after the tracer is injected, the gamma camera will begin to take pictures of your heart. In this special kind of test called SPECT (single photon emission computed tomography), the scanner rotates around you as it takes pictures. The table slides into the hole of the scanner, which is a large, donut-shaped machine.
  4. After the scan is completed, you may be allowed to leave the area, but will need to return for a second set of scans. The second set of scans will be taken 3 to 6 hours after the first set. During this time, you will not be allowed to eat or use tobacco and will be allowed limited water or decaffeinated/non-calorie liquids. In some cases, your healthcare provider may decide to have you return on another day for the second set of scans.
  5. The second set of scans will be much like the first set, but you will not need to exercise or get the medicine. You will lie on the table as before while the scanner takes pictures of your heart.
  6. Once the second set of scans has been completed, the IV line will be removed, and you will be allowed to leave, unless your healthcare provider tells you differently.

What happens after a stress myocardial perfusion scan?





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