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Physiologic and Pharmacologic Stressors

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Atlas of Nuclear Cardiology

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Abstract

Pharmacologic stress is a routinely utilized alternative to exercise stress in patients with a variety of indications. In combination with myocardial imaging, drugs binding to adenosine receptors (e.g., regadenoson, binodenoson) can selectively vasodilate comparatively normal coronary arterial beds more than two-fold (e.g., hyperemia) as compared to attenuated vasodilatory responses in post-stenotic beds, creating relative hypoperfusion reflected as a regional perfusion defect. Other drugs with positive chronotropic and/or inotropic effects (e.g., dobutamine, arbutamine) are administered to create demand ischemia in post-stenotic beds, with abnormal regional perfusion and/or segmental wall motion. The extent and severity of drug-induced perfusion and functional abnormalities is correlated with the risk of major adverse cardiac events (MACE), either perioperatively or in the setting of stable coronary artery disease or acute coronary syndromes. A normal or near-normal drug stress imaging study confers a low risk of MACE for 2 years. In the absence of relative or absolute contraindications (acute coronary syndromes, asthma, high degree atrioventricular block), the safety of drug stress myocardial imaging has been well established in numerous registries, including use in patients with treated chronic obstructive lung disease.

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Authors and Affiliations

  1. Department of Cardiology, Augusta University Medical Center, Augusta, GA, USA

    D. Douglas Miller

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  1. University of Maryland School of Medicine, Baltimore, MD, USA

    Vasken Dilsizian

  2. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Jagat Narula

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Miller, D.D. (2021). Physiologic and Pharmacologic Stressors. In: Dilsizian, V., Narula, J. (eds) Atlas of Nuclear Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-49885-6_5

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