Pharmacologic Stress Testing

Abstract Stress MPI using SPECT is widely used for CAD detection and risk stratification. While exercise is the preferred mode of stress in the majority of patients, pharmacologic stress is recommended for patients who have exercise limitations and patients with ventricular pre-excitation, LBBB, or artificially paced rhythms. Pharmacologic stress agents produce coronary hyperemia by completely different sets of mechanisms than exercise, but the hyperemia achieved with these agents is at least as intense as that achieved by maximal exercise. This chapter will discuss the pharmacology, mechanisms of action, hemodynamic effects, safety, and side effect profiles of the pharmacologic stress agents used for MPI and the protocols used with these agents either alone or when combined with exercise. The chapter also includes a description of the utility of pharmacologic stress MPI data on clinical management.