Adenosine stress testing

The patient, a 63-year-old Caucasian female, was hospitalized on 4 April 2002 though 10 April 2002 for a non-ST segment elevation myocardial infarction (non-Q-wave MI per chart documentation). She had a negative adenosine stress test after the initial event. Her serum cardiac-specific troponin I (cTnl) concentration 24 hours after her onset of chest pain was 1.4 pg/L (upper limit of normal is 0.3 ng/mL), and her creatine kinase (CK) MB level was 12.5 pg/L (upper limit of normal 6.0 ng/mL). Three days post-event her cTnl level was 0.5 pg/L and her CK-MB level was 4.5 pg/L (Fig. 5-1). MB refers to one of the isoenzyme forms of CK found in serum. The form of the enzyme that occurs in brain (BB) does not usually get past the blood-brain barrier and therefore is not normally present in the serum. The MM and MB forms account for almost all of the CK in serum. Skeletal muscle contains mainly MM, with less than 2% of its CK in the MB form. MM is also the predominant myocardial creatine kinase and MB accounts for 10%-20% of creatine kinase in heart muscle. 

In another study, 63 of 122 patients had breathlessness during cardiac stress testing with adenosine but none had associated bronchospasm (34). Pre-test lung function did not predict the risk of breathlessness and neither chronic obstructive airways disease nor smoking increased the risk. The authors concluded that breathlessness during adenosine stress testing is not due to bronchospasm. 

Alkoutami GS, Reeves WC, Movahed A. The frequency of atrioventricular block during adenosine stress testing in... 

Atrial fibrillation is an infrequent complication of adenosine treatment of supraventricular dysrhythmias, but is rare when it is used for diagnostic purposes. In a series of adenosine stress tests, atrial fibrillation occurred in 8 (0.41%) of 1948 patients and lasted from 15 seconds to 6 hours there was spontaneously reversion to sinus rhythm in all cases [12 ]. 

DIPYRIDAMOLE ANTIARRHYTHMICS t effect of adenosine 1 doses needed to terminate supraventricular tachycardias case report of profound bradycardia when adenosine infusion was given for myocardial stress testing Dipyridamole inhibits adenosine uptake into cells l bolus doses of adenosine by up to fourfold when administering it to treat supraventricular tachycardias. Some recommend avoiding adenosine for patients taking dipyridamole. Advise patients to stop dipyridamole for 24 hours before using adenosine infusions... 

A 75-year-old man who had had coronary bypass surgery was given an intravenous infusion of adenosine for stress testing (25). After 1 minute he developed a three-beat run of wide-complex tachycardia, followed by a 20-second run of a regular wide-complex tachycardia at a rate of 115/minute. There was left bundle branch block, and the tachycardia ended spontaneously. Adenosine infusion was continued and some ventricular extra beats with the same configuration occurred. In this case there was impaired perfusion of the left ventricle. 

The frequency of atrioventricular block has been studied in 600 patients who underwent stress testing with intravenous adenosine 140 micrograms/kg/minute for 6 minutes (29). The patients were young (under 49 years old n = 75), middle-aged (50-65 years n — 214), old (66-75 years n — 195), or very old (over 75 years n — 116). The respective frequencies of first-degree atrioventricular block were 15, 9.3, 14, and 17% (overall... 

The standard regimen for stress testing with intravenous adenosine is 140 micrograms/kg/minute for 6 minutes. However, in 599 patients a 3-minute infusion was associated with a lower frequency of some adverse effects (specifically flushing, headache, neck pain, and atrioventricular block) and had similar sensitivity in the diagnosis of coronary artery disease (43). 

Prabhu AS, Singh TP, Morrow WR, Mnzik O, Di Carli MF. Safety and efficacy of intravenous adenosine for pharmacologic stress testing in children with aortic valve disease or Kawasaki disease. Am J Cardiol 1999 83(2) 284-6. 

Toft J, Mortensen J, Hesse B. Risk of atrioventricular block during adenosine pharmacologic stress testing in heart transplant recipients. Am J Cardiol 1998 82(5) 696-7. 

Alkoutami GS, Reeves WC, Movahed A. The safety of adenosine pharmacologic stress testing in patients with first-degree atrioventricular block in the presence and absence of atrioventricular blocking medications. J Nucl Cardiol 1999 6(5) 495-7. 

Balan KK, Critchley M. Is the dyspnea during adenosine cardiac stress test caused by bronchospasm Am Heart J 2001 142(l) 142-5. 

Adenosine Negative chronotropic effect Hypersensitivity Effect on sinus node of denervated heart Life-threatening asystole (>0.5 min) may occur if used to treat supraventricular arrhythmia or stress testing... 

Cuocolo A, Nicolai E, Pace L, Nappi A, Sullo P, Cardei S, Argenziano L, Ell PJ, Salvatore M (1996) Technetium-99m-labeled tetrofosmin myocardial tomography in patients with coronary artery disease comparison between adenosine and dynamic exercise stress testing. J Nucl Cardiol... 

Dipyridamole reduces the bolus dose of adenosine necessary to convert supraventricular tachycardia to sinus rhythm by about fourfold. Profound bradycardia occurred in one patient taking dipyridamole when an adenosine infusion was given for myocardial stress testing. 

Kaney I, Hanon S, Van-Tosh A, Schweitzer P. Adenosine induced atrial fibrillation during pharmacologic stress testing. Report of eight cases and review of the literature. Int J Cardiol 2008 129(1) el5-7. 

Makaryus JN, Makaryus AN, Azer V, Diamond JA. Angioedema after injection of Tc-99 m sestamibi tracer during adenosine nuclear stress testing. J Nucl Cardiol 2008 15(4) e26-7. 

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