Myocardial Perfusion Imaging with Adenosine

Aka: Myocardial Perfusion Imaging with Adenosine, Stress Imaging with Adenosine, Pharmacologic Stress Test with Adenosine, Adenosine Nuclear Test, Adenosine Cardiolite, Pharmacologic Stress Test with Regadenoson, Lexiscan Cardiolite, Stress Nuclear Pharmacologic Perfusion Imaging

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II. Definitions

  1. Myocardial Perfusion Imaging with Adenosine
    1. Pharmacologic Stress Testing in which Adenosine is used to stimulate increased cardiac workload

III. Approach

  1. Hold nitrates (Nitroglycerin) on day of the test
  2. Hold methylzanthines 24 hours before test
    1. Theodur
    2. Aminophylline
    3. Dipyridamole

IV. Preparations

  1. Adenosine or
  2. Regadenoson (Lexiscan)
    1. Longer half life than Adenosine
    2. May be adminstered as bolus instead of continuous infusion

V. Advantages

  1. Short duration of Adenosine action (<3 seconds)
  2. Vasodilator increases coronary flow 5x
  3. More sensitive than Dobutamine (but less specific)
  4. ST Depression specific for serious disease
    1. Left main Coronary Artery Disease
    2. Three-vessel Coronary Artery Disease

VI. Indications

  1. Left Bundle Branch Block
  2. Paced Rhythm
  3. WPW Syndrome
  4. Moderate to severe renal dysfunction
  5. History of coronary revascularization
  6. Age >65 years

VII. Contraindications

  1. Hypotension with systolic Blood Pressure <90 mmHg
  2. Severe Hypertension >200/110 mmHg
  3. Significant atrial Arrhythmia without a functioning Pacemaker
    1. Sinus node disease
    2. Mobitz 2 or Third Degree AV Block
  4. Active Wheezing in bronchospastic disease
    1. Moderate to Severe Asthma
    2. Severe Chronic Obstructive Pulmonary Disease (COPD)
  5. Concurrent medication use
    1. Dipyridamole
    2. Aggrenox
    3. Theophylline
    4. Caffeine prior to test (e.g. Coffee, Chocolate)

VIII. References

  1. Busman and Pasternak (2026) Crit Dec Emerg Med 39(7): 5-13
  2. Cayley (2024) Am Fam Physician 110(6): 577-84 [PubMed]

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