Pharmacologic stress testing

If a patient is unable to perform an exercise test because of mobility problems, a pharmacologic stress test should be utilized (e.g., Dobutamine stress echocardiography).A man who cannot achieve 3-4 METs should be further evaluated by angiography if appropriate (3). 

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. 

Pharmacologic stress testing is used when patients cannot perform physical exercise to assess the likelihood of coronary artery disease. 

Travain MI, Wexler JR Pharmacological stress testing. Semin Nucl Med 1999 29 298-318. 

Englund A, Bergfeldt L, Rosenqvist M. Pharmacological stress testing of the His-Purkinje system in patients with bifascicular block. PACE 1998 21 1979-1987. 

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. 

The use of nuclear perfusion imaging in addition to exercise stress testing or as an alternative modality for patients unable to exercise (using pharmacologic agents) can provide important prognostic information for patients with chronic ischemic heart disease. 

Cardiovascular Takotsubo cardiomyopathy has been reported in an elderly woman who underwent pharmacological stress myocardial perfusion imaging with dipyridamole [55 ]. All abnormalities resolved completely 1 month after the initial stress test. 

It is interesting to note that pharmacological blockage of NKl receptors also revealed anxiolytic effects in the plus-maze test when mice from the 129/Sv strain (Santarelh et al. 2001), but not from other strains (Rodgers et al. 2004), were used. Thus, the anxiolytic effect of NKl receptor antagonists seems to be more sensitive to effects of the genetic background as compared to benzodiazepines. It is also possible that the relative contribution of the SP-NK1 system in the modulation of anxiety is situation dependent. The basal corticosterone levels in the blood plasma of NKIR and NK1 mice do not differ in low-stress situations, but the increase after the stressful elevated plus-maze test is blunted in the knockout animals (Santarelh et al. 2001). 

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