Myocardial Perfusion Imaging (MPI)

Myocardial perfusion imaging (MPI) is a non-invasive way to detect and assess coronary artery disease. It can help your doctor determine how severe your coronary artery disease might be and how much of your heart is affected.

The test uses a radioactive material (a radiopharmaceutical) which is usually injected into an arm vein and allows us to obtain images of your heart. A gamma camera is used to examine how well the radiopharmaceutical has been taken up by your heart muscle.

This exam is performed over two days:

• Day 1: A radiopharmaceutical is injected into your arm vein while at rest and images of your heart are taken. This appointment will last 1.5-2 hours.
• Day 2: A radiopharmaceutical is injected into your arm vein while exercising, and images of your heart are taken. If you’re unable to exercise on the treadmill, you may be given a medication (through your IV) that dilates your heart’s arteries to “mimic” a stress condition. This appointment will last 2-4 hours. Total exercise time is approximately 7-15 minutes.

HOW DO I PREPARE FOR MY EXAM?

DAY 1: Rest Study

• Four hours prior to your appointment, do not take anything by mouth – no smoking/vaping or use of Nitro spray, and don’t eat/drink/chew gum or tobacco.
• You may take small sips of water with prescribed medications.
• SPECIAL NOTE: If you take medication to manage your blood sugar, please do not take it on the morning of your test unless you have been given a late appointment time and are able to eat four hours before the test. If you cannot fast for four hours, eat a small meal and take your diabetes medication as prescribed, as long as there is at least two hours between eating and the time of your appointment. Remember to bring your insulin, oral medication, glucometer, and a snack.
• Continue taking all medications unless otherwise instructed by your physician.
• Please bring all medications, or a list of medications you are currently taking. If you are asthmatic, please ensure you bring your “puffer” medication with you.
• Bring a snack that contains a bit of fat (sandwich, muffin, bagel) to eat after your injection.
• Do not wear perfumes, colognes, or other scented products.
• Please arrive 15 minutes before your appointment to allow enough time to check in with reception and fill out paperwork.
• Bring photo identification, your provincial health card, and your requisition.

DAY 2: Stress Study

• Stop all beta blocker and calcium channel blocker medications 48 hours before your Day 2 appointment date. Please confirm with your referring physician prior to ceasing drugs.
• Do not consume any caffeine products (coffee, tea, pop, hot chocolate) in the 24 hours before your test. This includes medication that contains caffeine or caffeine derivatives (Tylenol 3, Anacin, Excedrin, No-Doz, Darvon, Caffregot, or Fiorinal).
• Four hours prior to your appointment, do not take anything by mouth – no smoking/vaping or use of Nitro spray, and don’t eat/drink/chew gum or tobacco.
• You may take small sips of water with prescribed medications.
• SPECIAL NOTE: If you take medication to manage your blood sugar, please do not take it on the morning of your test unless you have been given a late appointment time and are able to eat four hours before the test. If you cannot fast for four hours, eat a small meal and take your diabetes medication as prescribed, as long as there is at least two hours between eating and the time of your appointment. Remember to bring your insulin, oral medication, glucometer, and a snack.
• Continue taking all medications unless otherwise instructed by your physician.
• Please bring all medications, or a list of medications you are currently taking. If you are asthmatic, please ensure you bring your “puffer” medication with you.
• Bring a snack that contains a bit of fat (sandwich, muffin, bagel) to eat after your injection.
• Do not wear perfumes, colognes, or other scented products.
• Wear exercise clothing, such as a short-sleeved loose shirt, shorts or sweatpants, and clean and dry running shoes. No one-piece dresses or one-piece undergarments please.
• Please arrive 15 minutes before your appointment to allow enough time to check in with reception and fill out paperwork.
• Bring photo identification, your provincial health card, and your requisition.

WHAT HAPPENS DURING MY EXAM?

DAY 1: Rest Study

• You will fill out your paperwork. This will take approximately 15 minutes. (Please bring a translator with you if you need assistance filling out your forms.)
• The technologist will explain the complete procedure to you.
• You will be injected with a radiopharmaceutical into an arm vein. This material will be taken up by your heart muscle.
• Images of your heart will be taken 45 minutes later. These images take approximately 15 minutes to complete.
• For the images, you will be positioned on the imaging bed, with your arms above your head.
• During your wait, you will be asked to eat something fatty (this helps to contract the gallbladder and gives us better images of the heart). You are also able to drink a caffeine-free beverage (e.g., water, white milk, and juice).

DAY 2: Stress Study

• When you arrive in the morning, we’ll insert an intravenous (IV) line into your arm and attach electrodes to your chest. They will be connected to an electrocardiograph monitor (EKG) that charts your heart’s electrical activity during the test.
• A physician specializing in internal medicine will consult with you prior to the start of the test. If you have any medical questions concerning your test, this is an ideal time to discuss them.
• Before you start the exercise portion of the study, the technologist will take a resting EKG reading, measuring your resting heart rate. They will also take your blood pressure.
• We will then start you walking on the treadmill. It will start out very slow, then speed and incline will gradually increase, every three minutes. The majority of the program is a walking pace. Some patients may end up jogging.
• Your blood pressure will be taken a number of times while you are walking on the treadmill.
• The technologist will ask you how you are feeling throughout the test.
• Please tell your technologist if you feel short of breath, dizzy, lightheaded, or experience chest, arm or jaw pain, or discomfort, or if you have any other unusual symptoms.
• We will stop the test if you become too tired, experience chest pain, or when the technologist has enough information.
• If you are able to exercise on a treadmill, the radiopharmaceutical will be injected into the IV when you are near the peak of your exercise. You will then be required to walk an additional minute after the injection of the radiopharmaceutical.
• Most patients are on the treadmill for at least 5–10 minutes.
• If you are unable to walk on a treadmill, an alternative is available. A medicine called Persantine (or Dipyridamole) can be injected through the IV. This opens your heart’s blood vessels similar to exercise and allows us to “chemically stress” your heart. Our internal medicine physician will decide whether or not this is the preferred way of performing your exam.
• We will remove your IV and monitor you for about five minutes after you get off the treadmill to ensure that your heart rate and blood pressure are stable.
• You will then be required to eat and drink. Please bring food with you; your caffeine restrictions are lifted at this time.
• Approximately 25 minutes post-injection, we will take some images which will take approximately 15 minutes.

POST-EXAM INSTRUCTIONS

The radiopharmaceutical is excreted from the body through your urine. Keeping hydrated and voiding frequently will help eliminate it from your body.

WHEN WILL I GET MY RESULTS?

Both your rest and stress study will be processed and then reviewed by a nuclear medicine radiologist. Your referring practitioner will receive a copy of the following:

• Your rest and stress imaging report.
• Your specialist consultation report.
• Your treadmill report.

We will do our best to get the results to your doctor by the next business day. Please consult with your doctor regarding your results and any follow up exams or questions.

HOW MUCH WILL IT COST?

This exam is covered under your Alberta Health Care Plan. It is not currently offered at our Saskatchewan clinics. In certain circumstances (e.g., scuba diving or pilot’s license), you may be required to pay for the exam.