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Stress Test Chemicals Might Trigger Heart Attack! A cardiac stress test, or simply stress test, is used for heart disease. It can determine the amount of stress that the heart can manage before developing either an abnormal rhythm or evidence of ischemia (not enough blood flow to the heart muscle). When the heart is under stress, it will pump harder and faster than it does during most daily activities. This would reveal problems within the heart that might not be noticed otherwise. Stress response can be induced either by exercise or drug stimulation. Exercise stress test is the most commonly performed test that usually involves walking on a treadmill or pedaling a stationary bike with the heart rhythm, blood pressure and breathing monitored. For patients who have arthritis or are unable to exercise due to medical conditions, their doctors might ask them to take pharmacologic stress test, a diagnostic procedure in which cardiovascular stress being induced by pharmacologic agents. It can be used in combination with imaging modalities such as radionuclide imaging and echocardiography. Doctors might recommend stress test if they suspects that their patients have coronary artery disease or an irregular heart rhythm (arrhythmia). Stress test can determine whether there is adequate blood flow to the heart during increasing levels of activity, evaluate the effectiveness of the heart medications to control angina and ischemia, determine the likelihood of having coronary heart disease, identify abnormal heart rhythms and help develop a safe exercise program.
There is a variety of stress test including treadmill stress test, Dobutamine or Adenosine stress test, stress echocardiogram and nuclear stress test. Treadmill stress test is normally the first stress test performed if patient can walk and have a normal ECG while Dobutamine or Adenosine stress test is given to people who are unable to exercise. A drug is given to make the heart respond as if the person were exercising. Stress echocardiogram can show the graphic outline of the heart’s movement. Nuclear stress test helps determine which parts of the heart are healthy and function normally and which are not. A small amount of radioactive substance is injected into the patient. Then a special camera is used to identify the rays emitted from the substance within the body, and clear pictures of the heart tissue are produced on a monitor. These pictures are done both at rest and after exercise. On November 20, 2013, the Food and Drug Administration (FDA) announced that chemical agents used for stress test might trigger heart attack in patients. While the side effect is rare, it is serious and is related to 2 specific injectable drugs: Lexiscan and Adenoscan. Doctors are warned to avoid using these drugs in patients with signs or symptoms of unstable angina or heart problems because they might be at risk for a serious reaction. These drugs, when injected, can cause blood to flow to the healthier, unblocked arteries but reduce blood flow to the blocked artery that could lead to fatal heart attack. It is essential that trained medical staff with resuscitation equipment like a defibrillator should be available before administrating either of these drugs. Doctors and patients should also discuss any concerns or questions among themselves. After analyzing its safety database for Lexiscan for side effects reported between June 24, 2008, and April 10, 2013, and for Adenoscan from May 18, 1995, to April 10, 2013, FDA found that 26 heart attacks and 29 deaths following administration with Lexiscan, and 6 heart attacks and 27 deaths following administration with Adenoscan. The reports indicated the events tended to occur within 6 hours of a stress test. FDA also could not discern a difference in risk between the 2 chemicals. Some doctors do not think the new warning would change how they practice medicines because patients who cannot get on a treadmill and exercise for reasons other than injury are likely already at high risk for heart disease. Hence, these patients should be given angiography procedures if their heart needs to be evaluated.
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