What are the limitations of pharmacologic testing for cardiac assessment?

Updated: Nov 20, 2018
  • Author: Richard S Krause, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Theophylline can reduce ischemic changes on the ECG with vasodilator stress testing. Caffeine has been reported to have a similar effect. However, one study demonstrated that one cup of coffee, 1 hour prior to stress testing did not attenuate the results of adenosine nuclear imaging. [23] Calcium channel blockers, beta-blockers, and nitrates can also alter perfusion defects on pharmacologic stress tests and therefore ideally should be withheld for 24 hours prior to pharmacologic stress testing. Dipyridamole and adenosine can lead to bronchospasm; they are generally avoided in patients with severe reactive airway disease or active wheezing. Dobutamine is safe to use in these patients.

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