A Message From Carl Fier, MD, FACC

Dear Colleagues,

Recently the Department of Cardiology has seen an increase in requests to perform pharmacologic dobutamine stress echos that must be cancelled and changed due to a patient’s having a history of arrhythmia. Remember that dobutamine is relatively contraindicated in patients with a history of atrial fibrillation, SVT or other significant arrhythmias, due to its mechanism as a beta-1 receptor agonist.  When a reasonable alternative exists, such as a pharmacologic Lexiscan sestamibi nuclear stress test, we try to avoid dobutamine in order to prevent possible recurrence of the pre-existent arrhythmia.

When the need to cancel a dobutamine stress test arises, patients have vocalized frustration at the inconvenience.  Additionally, because nuclear isotope isn’t always readily available on an ad hoc basis, often times the patient needs to reschedule on a different day, adding to the delay and contributing to their anxiety.  Finally, for many insurers, nuclear stress testing needs prior authorization, which can add an additional several days to the process.

Attached please find the description of the various testing modalities as well as the contraindications.

If the practice pattern of your office is to submit an RFL for a  cardiac stress test and a PSR is ordering the test for you, please clarify with them that there are several options available and specify which test you feel  is most appropriate.

If questions ever arise as to the proper cardiac testing for a particular patient, please don’t hesitate to reach out to any of us in the Department via phone  (663-2311) or staff message. We would be happy to assist you in deciding upon the ideal test to answer the cardiac question that you are asking.

Sincerely,

Carl Fier