Risk of stress testing

Concerned about Adenosine stress test scheduled for 12/15. FDA warnings are frightening me considering I have cardiac instability, i.e., atril fib, fairly severe shortness of breath, suspected congestive heart failure having retained excess fluid in feet and lower legs for some time, fatigue.  I have recently had and am prone to bronchitis and wheezing. Do the risks of this test outweigh the risks for me. I am quite overweight. Is there another medication that can be ussed that is safer.  My cardiologist is quite intimidating and would like to approach her with concerns. Thank you for answering my question.

Exercise stress testing is the most widely used method to test a patient for coronary artery disease (CAD). For patients unable to exercise, pharmacologic stress testing is an alternative with drugs like Persantine, Adenosine and Dobutamine. This type of stress testing is used in combination with radionuclide imaging and echocardiography:

The result of an ECHO study during treadmill exercise and dobutamine stress testing

Adenosine will dilate (stretch) your coronary arteries. In areas of blockage this cannot happen thus resulting in less local blood flow, which can than be demonstrated with images such as the ones above. If you have history of asthma/reactive airway disease, you should probably avoid adenosine stress testing bcause of the risk of prolonged bronchospasm that may be difficult to treat. Likewise patients with heart block would be better of with another form of testing.

You should definitely discuss with your doctor whether your history of lung disease is such that adenosine should be avoided. An alternative would be to use dobutamine instead, as I suspect you would not be able to use a treadmill. Another alternative would be a CTCA to determine whether you have significant coronary artery blockages. 

Hope this helps,

Dr T



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