21
Stress Echocardiography Stress CMR CCTA*
• Limited acoustic windows (e.g., in
COPD patients)
• Inability to reach target heart rate
• Uncontrolled heart failure
• High-risk unstable angina, active
ACS or AMI (<2 d)
• Serious ventricular arrhythmia
or high risk for arrhythmias
attributable to QT prolongation
• Respiratory failure
• Severe COPD, acute pulmonary
emboli, severe pulmonary
hypertension
• Contraindications to dobutamine
(if pharmacologic stress test
needed)
▶ atrioventricular block,
uncontrolled atrial fibrillation
▶ Critical aortic stenosis
b
▶ Acute illness (e.g., acute PE,
acute myocarditis/pericarditis,
acute aortic dissection)
▶ Hemodynamically significant
LV outflow tract obstruction
▶ Contraindications to atropine
use:
» Narrow-angle glaucoma
» Myasthenia gravis
» Obstructive uropathy
» Obstructive gastrointestinal
disorders
» Severe systemic arterial
hypertension (e.g.,
≥200/110 mm Hg )
Use of Contrast Contraindicated in:
• Hypersensitivity to perflutren
• Hypersensitivity to blood, blood
products, or albumin (for Optison
only)
• Reduced GFR (<30
mL/min/1.73 m
2
)
• Contraindications
to vasodilator
administration
• Implanted devices
not safe for CMR
or producing
artifact limiting
scan quality/
interpretation
• Significant
claustrophobia
• Caffeine use within
last 12 h
• Allerg y to iodinated
contrast
• Inability to
cooperate with scan
acquisition and/
or breath-hold
instructions;
• Clinical instability
(e.g. acute
respiratory distress,
severe hypotension,
unstable
arrhythmia);
• Renal impairment
as defined by local
protocols
• Contraindication
to beta blockade in
the presence of an
elevated heart rate
and no alternative
medications
available for
achieving target
heart rate;
• Heart rate
variability and
arrhythmia;
• Contraindication
to nitroglycerin (if
indicated)
