Should a nuclear stress test be the first step if a patient has been diagnosed with "white coat" syndrome?

Question

For years, the doctors have told me my blood pressure is high. I monitor it at home with normal results. The cardiologist did a normal stress test and an echocardiogram four years ago. He states now he doesn't expect the results to be any different, but suggests a nuclear stress test. I am very leary of any injectables without sufficient cause. What are the real risks involved with complications?

Answer 1

guppy - I'm not completely clear what your question is, but I will try to help.

It is certainly safe for someone with "white coat hypertension" to get a nuclear stress test. The dose of radiation that a patient is exposed to during a nuclear stress test is low, comparable to that from 2-4 CT scans depending on which isotope your hospital uses. Also, if your doctor chooses to do an adenosine stress test, the adenosine can occasionally lead to transient heart block or cause bronchospasm in people with asthma. However, both of these resolve very quickly once the adenosine is stopped.

Whether you actually NEED a stress test is an entirely different question. The reason to do a stress test is if you are having symptoms that you doctor thinks might be due to coronary disease. The stress test us if you are more likely or less likely to have real coronary disease. Another reason is for risk stratification for people who are preparing to undergo a major surgery. If you are not having any symptoms that are concerning for heart disease (chest pain or pressure, pain down your arm, nausea with exercise, etc.) then having a nuclear stress test may not be of much benefit to you. It would help if you give us some more info in this regard.

Hope that helps!

Answer 2

I was told it's a very safe test. Of course, there are always one or two people that 'react' to even Tylenol, so It would be very rare to have a reaction to the injection. Of course, if you had heart trouble, you could have more on the stress test. It's been shown to pick up abnormalities that the usual stress test doesn't. It's usually the preferred method of testing these days. Ask your doc office to send you info prior to the test. You always have the right to say no, just remember not to play the blame game if something comes up that was avoidable.