The use of pharmacologic stress testing for detecting and assessing ischemic heart disease (IHD) is reviewed. Methods of diagnosing IHD are designed to emulate conditions that increase myocardial oxygen demand in order to identify areas of ischemia and atherosclerotic lesions and to evaluate their functional or anatomical importance. Diagnostic methods can be divided into functional assessment with stress testing and anatomical assessment with coronary angiography. Physical stressors, such as exercise or atrial pacing, or pharmacologic stressors, such as vasodilators or beta-adrenergic-receptor agonists, can be used in stress testing. Electrocardiography, thallium planar scintigraphy, echocardiography, and other techniques are used to evaluate the response to stress testing. Unlike exercise stress testing, pharmacologic testing does not require physical exertion. Adenosine, dipyridamole, and dobutamine are the principal agents used in pharmacologic stress testing. Adenosine and dipyridamole mediate coronary artery vasodilation. Adenosine, a direct agonist, has a rapid onset and short duration of action. Dipyridamole, the only agent with approved labeling for use in stress testing, inhibits adenosine indirectly. Dobutamine increases cardiac output and heart rate as well as promoting coronary artery vasodilation. Clinical trials show that all three drugs can be used safely and effectively in patients after acute myocardial infarction or before vascular surgery and in individuals with risk factors for or symptoms of IHD. The sensitivity and specificity of pharmacologic stress testing for detecting IHD are at least as high as those of exercise testing. Minor adverse effects, including chest pain, headache, and facial flushing, are common, but major adverse effects are rare. Pharmacologic stress testing can be used in patients who cannot undergo exercise testing and offers a noninvasive alternative to coronary angiography.

 

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S. M. Shea, D. S. Fieno, B. E. Schirf, X. Bi, J. Huang, R. A. Omary, and D. Li T2-prepared Steady-State Free Precession Blood Oxygen Level-Dependent MR Imaging of Myocardial Perfusion in a Dog Stenosis Model Radiology, August 1, 2005; 236(2): 503 - 509. [Abstract] [Full Text] [PDF]

				G. Zhao, A. Linke, X. Xu, M. Ochoa, F. Belloni, L. Belardinelli, and T. H. Hintze Comparative Profile of Vasodilation by CVT-3146, a Novel A2A Receptor Agonist, and Adenosine in Conscious Dogs J. Pharmacol. Exp. Ther., October 1, 2003; 307(1): 182 - 189. [Abstract] [Full Text] [PDF]

				X. M. Zheng and R. C. Williams Serum Caffeine Levels After 24-Hour Abstention: Clinical Implications on Dipyridamole 201Tl Myocardial Perfusion Imaging J. Nucl. Med. Technol., September 1, 2002; 30(3): 123 - 127. [Abstract] [Full Text] [PDF]