20
Treatment
Table 3. Contraindication by Type of Imaging Modality and
Stress Protocol
Exercise ECG
Stress Nuclear
a
• Abnormal ST changes on resting
ECG, digoxin, left bundle branch
block, Wolff-Parkinson-White pattern,
ventricular paced rhythm (unless test is
performed to establish exercise capacity
and not for diagnosis of ischemia)
• Unable to achieve ≥5 METs or unsafe
to exercise
• High-risk unstable angina or AMI
(<2 d) i.e., active ACS
• Uncontrolled heart failure
• Significant cardiac arrhythmias (e.g.,
VT, complete atrioventricular block) or
high risk for arrhythmias caused by QT
prolongation
• Severe symptomatic aortic stenosis
• Severe systemic arterial hypertension
(e.g., ≥200/110 mm Hg )
• Acute illness (e.g., acute PE, acute
myocarditis/pericarditis, acute aortic
dissection)
• High-risk unstable angina, complicated
ACS or AMI (<2 d)
• Contraindications to vasodilator
administration
▶ Significant arrhythmias (e.g.,
VT, second- or third-degree
atrioventricular block) or sinus
bradycardia <45 bpm
▶ Significant hypotension
(SBP <90 mm Hg )
▶ Known or suspected
bronchoconstrictive or
bronchospastic disease
▶ Recent use of dipyridamole
or dipyridamole-containing
medications
▶ Use of methylxanthines (e.g.,
aminophylline, caffeine) within
12 hours
▶ Known hypersensitivity to
adenosine, regadenoson
• Severe systemic arterial hypertension
(e.g., ≥200/110 mm Hg )
For all the imaging modalities, inability to achieve high-quality images should be
considered, in particular for obese patients
a
Screening for potential pregnancy by history and/or pregnancy testing should be performed
according to the local imaging facilities policies for undertaking radiological examinations that
involve ionizing radiation in women of child-bearing age.
†
Low-dose dobutamine may be useful for assessing for low-gradient AS.
