Cor Vasa 2004, 45(5):210-213
Adding atropine to exercise stress testing for better performance of myocardial perfusion imaging
- 1 Klinika nukleární medicíny, Fakultní nemocnice Královské Vinohrady a 3. lékařská fakulta Univerzity Karlovy, Praha
- 2 Klinika nukleární medicíny, Fakultní nemocnice s poliklinikou a Lékařská fakulta Univerzity Palackého, Olomouc, Česká republika
Introduction:
Almost 30% of patients referred to myocardial stress testing are not able to achieve the appropriate heart rate during exercise.
Aim:
To evaluate the efficacy of a combination of atropine with physical stress in these patients to define its frequency in routine clinical practice with respect to inter-physician variability, and to evaluate its safety.
Material and methods:
374 patients were referred for stress myocardial perfusion imaging, of this number, 39 (27 males and 12 females) were evaluated using atropine. Atropine was administered intravenously at a dose of 1 mg, as indicated by the test-performing physician, in the absence of criteria for test termination and in the absence of contraindications. Two physicians participated in the study.
Results:
38 patients received atropine from physician A and 1 from physician B, p = 0.000. Heart rate increased by 24 ± 7 bpm on average. It was significantly higher than appropriate on average by 9 ± 9 bpm (p = 0.000). 36/39 (92%) patients achieved more than 85% of age-related maximal heart rate. The increase in heart rate did not depend on beta-blocker use. Only 2/39 test results were inconclusive. Side effects were infrequent; they were registered in 2/39 (5%) patients and were not serious (dry mouth).
Conclusion:
The addition of intravenous atropine at a dose of 1 mg to bicycle ergometry in patients with chronotropic incompetence is effective. Following atropine administration, over 92% of evaluated patients achieved more than 85% of predicted age-related heart rate. Atropine use in routine clinical practice is not frequent, and it strongly depends on the physician performing the test. It is also safe, adverse effects were registered very rarely and were not serious. This is a good alternative to other types of stress, it is fast and readily available, and can save time.
Keywords: Atropine; Stress test; Myocardial perfusion SPECT
Published: May 1, 2004 Show citation