Pharmacologic Stress Imaging

Abstract

Pharmacologic stress imaging has increasingly been employed as an alternative to exercise imaging for detection of coronary artery disease and risk stratification particularly in patients who are unable to perform adequate exercise. Sensitivity and specificity of thallium 201 scintigraphy using intravenous dipyridamole infusion as a stress for coronary artery disease detection average 85% and 91%, respectively. Dipyridamole imaging is also useful for differentiating between ischemia and scar and identifying patients who have an increased risk for subsequent cardiac events. Dipyridamole imaging is particularly useful for preoperative risk stratification in patients undergoing surgery for peripheral vascular or aortic disease. Dipyridamole imaging is also useful for identifying residual myocardial ischemia after myocardial infarction and detecting restenosis after coronary angioplasty. Adverse side effects of dipyridamole are promptly reversed by aminophylline. Dipyridamole stress can also be employed in association with echocardiography for detection of ischemia-induced regional wall motion abnormalities.

Dipyridamole and paracetamol overdose resulting in multi-organ failure

“…Chest pain, headache, dizziness, ischaemic changes on ECG and hypotension are well-documented. 9 Dipyridamole has a bioavailability of between one and two-thirds, and is heavily protein-bound. It primarily undergoes hepatic metabolism whilst renal elimination is minimal.…”

Utility of Stress Testing and Coronary Calcification Measurement for Detection of Coronary Artery Disease in Women

“…61 While the overall diagnostic accuracy of pharmacologic perfusion imaging is similar to that of exercise perfusion imaging, the latter technique provides prognostic information unavailable from the pharmacologic testing. 62,63 For example, an inability to walk for 6 minutes or longer on a Bruce protocol is by itself associated with an increased coronary heart disease event rate. Recently, Kim et al 63 reported that maximum sensitivity could be ob-tained by using a vasodilator combined with SPECT imaging, while maximum specificity was found in studies using a vasodilator with echocardiography.…”

Cardiovascular Magnetic Resonance Imaging

“…Adenosine or dipyridamole are also commonly administered as pharmacologic stress agents 32,33 . These agents promote systemic arterial vasodilation during stress testing 31,32 .…”

“…These agents promote systemic arterial vasodilation during stress testing 31,32 . Patients commonly experience mild side effects including flushing, chest discomfort, anxiety, mild dyspnea, and headache 33 . Major side effects occur only approximately 2% of patients receiving intravenous adenosine.…”