Hhc nuclear instruction sheet

THE HUNTINGTON HEART CENTER
172 EAST Main Street, Huntington, NY 11743
Tel: (631) 385-0022 Fax: (631) 385-0896
Raj Patcha MD Marco Papaleo MD, Balveen Singh MD, Raja Varma MD Sotir Polena MD
APPOINTMENT DATE:________________________________TIME:______AM / PM
PURPOSE OF PROCEDURE:
This is a diagnostic test to evaluate chest pain, shortness of breath, to detect the presence of early
heart disease, to assess your functional capacity or to update the status of your coronary circulation
following a cardiac event.
PROCEDURE
You will receive an intravenous injection of Myoview, a radioactive tracer that identifies areas of
decreased blood flow to the heart muscle. The intravenous started in your arm will be used
throughout the test which takes approximately 4 hours. You will undergo a set of heart scans.
Electrodes will also be placed on your chest and you will be connected to a stress monitor for a series
of ECGs to be taken before, during and after exercising. You will then walk on a treadmill until you
reach your maximum heart rate or until you need to stop. (For patients who are unable to walk on a
treadmill, a substance will be administered to allow us to see how your heart would function during
exercise.)
INSTRUCTIONS PRIOR TO YOUR TEST
1. NO CAFFEINE
FOR 24 HOURS BEFORE TEST
This includes coffee, decaf coffee, all teas, all chocolate foods and beverages, all sodas of any
kind
2. DO NOT
EAT FOOD 3 HOURS BEFORE TEST
3. BRING A SNACK WITH YOU
a. You will be able to eat at one point during the test if you are hungry
b.
A dairy snack is best, such as yogurt, cottage cheese or a cheese sandwich
4. MEDICATIONS:
a. DO NOT take Beta Blockers the night before and on the morning of your test
(see reverse side for listing)
b. DO NOT take Blood Pressure Medications on test day
c. Bring ALL medications with you, as the doctor will advise you about your other
Medications
5. FOR DIABETICS
Be sure to eat 2 hours before the test
For Non-Insulin dependent patients-take pills as directed
For Insulin dependent patients, take ½ your usual dose
6. CLOTHING:
a. Wear sneakers and loose, comfortable clothing
b. Short sleeves is preferred without zippers or metal from the waist up
c. Do NOT use skin lotions, oils, perfumes, or powders on your chest
d.
Remove all jewelry
e. Females will be asked to remove their bras for entire test including sports bras
f.
Bring a sweater or sweatshirt with no zippers or metal buttons. The department is
kept cool
PATIENT RESPONSIBILITY
If OUR doctors did not order this test, you are responsible for any authorizations and/or referrals
that you might need. Please contact your PCP.
If you do not follow the instructions given to you and your test cannot be performed, or if you do not
give at least 24 hours notice should you need to cancel, you will be expected to pay for the dosages
or radiopharmaceuticals which are ordered prior to your test. The fee is $200.00.( You are being
given a separate form today which gives more detailed information about this fee. You will sign it
and we will retain it for our records.)
Our office will call your home to confirm your appointment at least 24 hours before your test. If you
cannot be reached by our office and you do not call to confirm your appointment your test will be
canceled and your appointment will be given to another patient.
If you do not provide current, correct insurance information at the time your appointment is made
or did not provide any referrals and/or authorizations necessary for this test, you will be held
responsible for the full payment of this test which currently, is $2,000. You will also be responsible
for any unpaid portions of your deductible or coinsurances as they may apply to this procedure.
OTHER COMMENTS
There are no harmful effects to you from the use of the radioactive substance.
BETA-BLOCKERS
Atenolol
Normodyne
Trandate
Acebutolol
Penbutalol
Betaxolol
Inno Pran XL
Pindolol
Bisoprolol
Propanolol
Blocadren
Labetalol
Breviblock
Tenoretic
Bystolic
Lopressor
Tenormin
Carvedilol
Metoprolol
Chlorthaidone
Nebivolol
OTHER MEDICATIONS THAT SUPPRESS HEART RATE-Do not take the night
before or the morning of your test:
Calan (SR)
Cardizem
Diltiazem
Verapamil

Source: http://huntingtonheartcenter.com/_content/services/forms/HHC%20NUCLEAR%20INSTRUCTION%20SHEET.pdf