- Five min after stress injection, get spect from 45° RAO to LPO, 32 views each 40 sec over 180° and high resolution collimator.

- Reinject 1 mCi after spect stress completion in particular for viability evaluation.

- Repeat same acquisition 3 h - 4 h later at resting condition.

- For heart lung ratio take an anterior static image for 3-5 min after stress.

- For viability assessment, administer sublingual nitrates. Use of 5-10 mg isosorbide mononitrate  10 min before resting phase or reinjection, . Alternatively 5 mg nitroglycerin can be employed.  It must be used cautiously in patients on erectile dysfunction medications, those with severe anemia and in cases with aortic stenosis or other preload-dependant cardiac pathologies. Likewise, if the resting viability phase follows stress with dypiridamole. In all these cases, keep patient supine for 30 min after the final acquisition, check blood pressure and allow the patient to go to the standing position gradually, in order to prevent fainting.

- Administer iv aminophylline 125 mg if patient complain of headache or nausea/vomitus after the test.

- Right after the end of stress spect, check the acquisition to detect patient motion, bowel superimposition over the heart and in males for inferior wall attenuation. If so, a prone spect acquisition is useful to make a differential with an infarction (fixed defect), because attenuation artefact will disappear from supine to prone spect.

References:

1 Mut F. Diagnostico de la Enfermedad Coronaria and Gonzalez P et al. Viabilidad Miocardica, in Medicina Nuclear Aplicaciones Clínicas. Ignasi Carrio y Patricio González . Editorial Masson, Barcelona España, 2003, p 39-56 and 105-119, respectively.

2 Hesse B et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging. 2005 Jul;32(7):855-97.