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Pharmacologic Stress Testing Medication

  • Author: David Akinpelu, MD, FACP; Chief Editor: Eric H Yang, MD  more...
 
Updated: Aug 05, 2016
 

Medication Summary

Adenosine, dipyridamole (Persantine), and dobutamine are the most widely available pharmacologic agents for stress testing. Regadenoson, an adenosine analog, has a longer half-life than adenosine, and therefore a bolus versus continuous administration.

Adenosine, dipyridamole, and regadenosine are cardiac vasodilators. They dilate coronary vessels, which causes increased blood velocity and flow rate in normal vessels and less of a response in stenotic vessels. This difference in response leads to a steal of flow, and perfusion defects appear in cardiac nuclear scans or as ST-segment changes.

Dobutamine is a cardiac inotrope and chronotrope. The heart responds to dobutamine similarly to the way it responds to exercise.

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Diagnostic Agents

Class Summary

Pharmacologic stress agents are used in myocardial perfusion for diagnostic purposes.

Adenosine (Adenoscan, Adenocard)

 

When used in myocardial perfusion scintigraphy reveals areas of insufficient blood flow. Adenosine increases blood flow and causes coronary vasodilation in normal coronary arteries while it causes little or no increase in stenotic coronary arteries. Adenosine is also a short-acting agent that alters potassium conductance into cells and results in hyperpolarization of nodal cells. This increases the threshold to trigger an action potential and results in sinus slowing and blockage of AV conduction. As a result of its short half-life, adenosine is best administered in an antecubital vein as an IV bolus followed by rapid saline infusion.

Regadenoson (Lexiscan)

 

Pharmacologically induces stress in patients unable to undergo adequate exercise-induced stress. Acts as low-affinity agonist for A2A adenosine receptor. Produces coronary vasodilation and increased coronary blood flow in normal nonstenotic arteries. Indicated for radionuclide myocardial perfusion imaging.

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Antiplatelet Agents, Cardiovascular

Class Summary

Agents in this class inhibit the activation of factors responsible for platelet aggregation.

Dipyridamole (Persantine)

 

Platelet adhesion inhibitor that possibly inhibits RBC uptake of adenosine, itself an inhibitor of platelet reactivity. In addition, may inhibit phosphodiesterase activity leading to increased adenosine, adenine nucleotides, and cyclic-3', 5'-adenosine monophosphate within platelets. These mediators subsequently inhibit platelet aggregation and may cause vasodilation.

H3 Beta1/Beta2 Adrenergic Agonists

 

Agents in this class that stimulate beta1-adrenergic receptors and that have little effect on beta2 or alpha receptors are used. The agents cause increased contractility and heart rate.

Dobutamine

 

Synthetic catecholamine and a direct inotropic agent that stimulates cardiac beta-receptors with minimal increase in systemic vascular resistance.

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Contributor Information and Disclosures
Author

David Akinpelu, MD, FACP Emergency Medicine Attending Physician, Riverside Tappahannock Hospital/Riverside Shore Memorial Hospital, Riverside Medical Group

David Akinpelu, MD, FACP is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ronald J Oudiz, MD, FACP, FACC, FCCP Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Liu Center for Pulmonary Hypertension, Division of Cardiology, LA Biomedical Research Institute at Harbor-UCLA Medical Center

Ronald J Oudiz, MD, FACP, FACC, FCCP is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American Thoracic Society, American College of Physicians, American Heart Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Actelion, Bayer, Gilead, Lung Biotechnology, United Therapeutics<br/>Received research grant from: Actelion, Bayer, Gilead, Ikaria, Lung Biotechnology, Pfizer, Reata, United Therapeutics<br/>Received income in an amount equal to or greater than $250 from: Actelion, Bayer, Gilead, Lung Biotechnology, Medtronic, Reata, United Therapeutics.

Chief Editor

Eric H Yang, MD Associate Professor of Medicine, Director of Cardiac Catherization Laboratory and Interventional Cardiology, Mayo Clinic Arizona

Eric H Yang, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Additional Contributors

Justin D Pearlman, MD, ME, PhD, FACC, MA Chief, Division of Cardiology, Director of Cardiology Consultative Service, Director of Cardiology Clinic Service, Director of Cardiology Non-Invasive Laboratory, Chair of Institutional Review Board, University of California, Los Angeles, David Geffen School of Medicine

Justin D Pearlman, MD, ME, PhD, FACC, MA is a member of the following medical societies: American College of Cardiology, International Society for Magnetic Resonance in Medicine, American College of Physicians, American Federation for Medical Research, Radiological Society of North America

Disclosure: Nothing to disclose.

Acknowledgements

Javier M Gonzalez, MD Consulting Staff, Department of Cardiology, Citrus Cardiology Consultants

Javier M Gonzalez, MD is a member of the following medical societies: American College of Cardiology and American Medical Association

Disclosure: Nothing to disclose.

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Normal radionuclide uptake (dipyridamole-Cardiolite).
ECGs show a normal sinus rhythm and a sinus rhythm with a left bundle branch block.
ECG depicts electrophysiologic events of left bundle branch block.
Table 1. Findings and Likely Associated Results
ResultsRestStressConclusion
FindingsNormalNormalBlood flow to coronary artery is likely normal
FindingsNormalReversible perfusion defectArtery blockage may be present
FindingsAbnormalAbnormalHeart has had prior injury, eg, previous heart attack
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