Theophylline and Caffeine as Alternatives During an Aminophylline Shortage

2018 ◽  
Vol 53 (3) ◽  
pp. 316-320 ◽  
Author(s):  
Emily L. Singleton ◽  
Nancy Le ◽  
Genevieve Lynn Ness
Keyword(s):  
Stress Testing ◽  
Stress Test ◽  
Pharmacological Stress ◽  
Drug Shortage ◽  
Reversal Agent ◽  
Cardiac Stress ◽  
Reversal Agents ◽  
Diagnosis And Prognosis ◽  
Pharmacological Stress Testing ◽  
Pharmacological Stress Test

The latest aminophylline shortage has prompted a need for alternative reversal agents for pharmacological stress testing. Cardiac stress testing is common for diagnosis and prognosis in patients with coronary heart disease. Options for pharmacological stress test agents include adenosine, regadenoson, dipyridamole, and dobutamine, whereas aminophylline is the recommended reversal agent. Adenosine and dobutamine can be used as alternatives to regadenoson and dipyridamole to decrease or eliminate the use of aminophylline. Alternatives to aminophylline include theophylline and caffeine. It is important to efficiently identify alternatives during a drug shortage to maintain optimal patient outcomes.

scholarly journals Possibilities of applying pharmacological stress testing in assessment of heart functional capacity in dogs

2010 ◽  
Vol 64 (3-4) ◽  
pp. 287-296
Author(s):  
Ljubica Kosic-Spasojevic ◽  
Dragisa Trailovic
Keyword(s):  
Functional Capacity ◽  
Stress Testing ◽  
Stress Test ◽  
Body Burden ◽  
The Body ◽  
Moderate Physical Activity ◽  
Clinical Implementation ◽  
Pharmacological Stress ◽  
Dobutamine Stress Test ◽  
Pharmacological Stress Testing

Systolic and diastolic heart functions, evaluated using echocardiography, do not reflect the functional capacity of the patient and they cannot explain the occurrence of symptoms during a certain degree of activity. Evaluation of the functional capacity is an integral part of cardiological examinations in human medicine. Functional examinations of the heart can be carried out using the body burden test or pharmacologically. Investigations carried out so far into canine cardiology have not contributed to the clinical implementation of functional heart examinations in dogs. Pharmacological stress testing is an optimal way to perform a functional heart examination in dogs. Since it reflects the effects of moderate physical activity, dobutamine has been recommended as the medicine of choice for provoking a pharmacological stress test. This work presents a review of the results of the most important investigations, as well as our own investigations, of the application of the dobutamine stress test (DST) in dogs, and the problems in investigations so far have been considered and future directions for DST investigations pointed out. .

scholarly journals Study of efficacy and safety of pharmacological stress tests in nuclear cardiology

2009 ◽  
Vol 66 (3) ◽  
pp. 193-198 ◽  
Author(s):  
Branislav Baskot ◽  
Saso Rafajlovski ◽  
Andjelka Ristic-Angelkov ◽  
Slobodan Obradovic ◽  
Branko Gligic ◽  
...  
Keyword(s):  
Side Effects ◽  
Stress Testing ◽  
Stress Test ◽  
Stress Tests ◽  
Pharmacological Stress ◽  
Safety And Efficacy ◽  
Low Level ◽  
Low Intensity ◽  
Pharmacological Stress Test ◽  
Low Intensity Exercise

Background/Aim. Treadmill test combined with myocardial perfusion scintigraphy (MPS) is a commonly used technique in the assessment of coronary artery disease. Many patients who cannot adequately perform exercise stress testing may nevertheless undergo pharmacological tests, most commonly with the vasodilator agents (adenosine and dipyridamole), as well as the positive inotropic agent dobutamine. Patients undergoing vasodilators stress testing with either dipyridamole or adenosine also perform simultaneous low-intensity exercise. The aim of this study was to compare various pharmacological stress tests alone or in combination with low intensity exercise as preparation for MPS in reagard to incidence of adverse effects, quality of diagnostic image and the acquisition initial time. Methods. A total of 2 205 patients underwent pharmacological stress tests. Pharmacological stress test with adenosine was applied in 493 patients. In 405 of them we performed concomitant low level exercise (50 W) by bicycle ergometar (AdenoEX). In 88 of them we performed adenosine abbreviated protocol (AdenoSCAN). In 1 526 patients we performed pharmacological stress test with dipyridamole. In 871 of them we performed concomitant low level exercise (50 W) by bicycle ergometar (DipyEX), and in 775 we used only dipyridamole protocol (DipySCAN). In 186 patients we used pharmacological stress test with dobutamine. We followed side effects of adenosine, dipyiridamole and dobutamine, compared results between protocols with concomitant low level exercise and vasodilatators only. We also compared image quality, and suggested time of acquisition after stress test. Results. We found numerous side effects especially with adenosine, but these effects were short-lived and not required active interventions. Benefit with concomitant exercise in booth AdenoEX and DipyEX included decreased side effects (AdenoEX vs AdenoSCAN 62% vs 87%, respectively, and DipyEX vs DipySCAN 37% vs 59%, respectively) improved safety and patients tolerance, improved target-to-background ratios because of less subdiaphragmal activity, and earlier acquisition time. Because of producing a lot of arrhythmias (in 49% of patients) dobutamin was considered a last choice for pharmacological stress testing. Conclusion. Safety and efficacy of vasodilatators (adenosine, dipyridamole) pharmacological stress tests are good, but with concomitant exercise even better. The safety and efficacy of adenosin are better than those of dipyridamole. AdenoEX protocol provides good safety and patients tolerance. In light of these benefits we recommend AdenoEX whenever possible. Dobutamine is the last pharmacological toll for MPS.

Abstract MP44: Assessment and Comparison of Six minute Walk Distance in Patients Undergoing Pharmacological Stress Test

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Azhar A Supariwala ◽  
Seth Uretsky ◽  
Randy Cohen ◽  
Yathin Thammaiah ◽  
Swathi Sangli ◽  
...  
Keyword(s):  
Stress Testing ◽  
Stress Test ◽  
Exercise Stress ◽  
Pharmacological Stress ◽  
Walk Distance ◽  
Stress Mode ◽  
Objective Evidence ◽  
Pharmacological Stress Test ◽  
Minute Walk Distance ◽  
Minute Walk

Background: Stress testing is widely used for diagnosis, risk stratification and prognosis of patients (pts). Although a normal stress study identifies pts at low risk, compared to exercise stress (Ex), those undergoing pharmacological stress test (PST) are at a higher risk of mortality. We studied the feasibility of a six minute walk test (SMWT) and compared the six-minute walk distance (SMWD) among Ex and PST. Methods: 328 consecutive patients [Ex=186 (57%); PST= 142 (43%)] referred for stress testing at our hospital were enrolled. Demographic and clinical information was collected. Each patient underwent a SMWT according to American Thoracic Society guidelines. Results: Patients in PST were older (62±14 vs. 57±12; p=0.001), had a higher BMI (36±30 vs. 29±6; p0.01), diabetes (46% vs. 25%; p<0.001) and hyperlipidemia (55% vs. 38%; p=0.01). We found a low SMWD achieved in PST (209 m ± 131) vs. Ex (366 m ± 107; p<0.001). When compared to age-gender matched healthy volunteer data, we found a significantly lower predicted SMWD in all patients suspected of CAD, with the lowest predicted SMWD in PST. (Figure) On multivariate analyses, patients undergoing PST had the highest risk (HR=10.1) of achieving lowest tertile of percent predicted SMWD, followed by female gender (HR=2.0), history of CHF, higher BMI. Only patients above 80 yrs of age had significant higher likelihood of undergoing pharmacological stress mode (OR = 7.2; 95CI =1.7 - 30.1; p=0.008). After including the interaction term for age and pharmacological stress mode, low SMWD among PST was seen in both older and young patients (p for interaction=0.46). Conclusion: SMWT is feasible in patients referred for PST. Patients with known or suspected CAD achieve a low percent predicted SMWD. This is the first study to show objective evidence of deconditioning in PST irrespective of co-morbidities. Future studies are needed to evaluate the prognostic significance of SMWT in patients undergoing pharmacological stress test.

scholarly journals Comparison of Preoperative Assessment of Patient’s Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Adam S. Weinstein ◽  
Martin I. Sigurdsson ◽  
Angela M. Bader
Keyword(s):  
Cardiac Failure ◽  
Stress Testing ◽  
Stress Test ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Exercise Stress ◽  
Cardiac Stress ◽  
Metabolic Equivalents ◽  
Cardiac Stress Testing ◽  
Cardiac Stress Test

Background. Preoperative anesthetic evaluations of patients before surgery traditionally involves assessment of a patient’s functional capacity to estimate perioperative risk of cardiovascular complications and need for further workup. This is typically done by inquiring about the patient’s physical activity, with the goal of providing an estimate of the metabolic equivalents (METs) that the patient can perform without signs of myocardial ischemia or cardiac failure. We sought to compare estimates of patients’ METs between preoperative assessment by medical history with quantified assessment of METs via the exercise cardiac stress test. Methods. A single-center retrospective chart review from 12/1/2005 to 5/31/2015 was performed on 492 patients who had preoperative evaluations with a cardiac stress test ordered by a perioperative anesthesiologist. Of those, a total of 170 charts were identified as having a preoperative evaluation note and an exercise cardiac stress test. The METs of the patient estimated by history and the METs quantified by the exercise cardiac stress test were compared using a Bland–Altman plot and Cohen’s kappa. Results. Exercise cardiac stress test quantified METs were on average 3.3 METS higher than the METs estimated by the preoperative evaluation history. Only 9% of patients had lower METs quantified by the cardiac stress test than by history. Conclusions. The METs of a patient estimated by preoperative history often underestimates the METs measured by exercise stress testing. This demonstrates that the preoperative assessments of patients’ METs are often conservative which errs on the side of patient safety as it lowers the threshold for deciding to order further cardiac stress testing for screening for ischemia or cardiac failure.

Blood pressure and risk of cognitive impairment. The role of vascular disease in neurodegeneration.

2019 ◽  
Author(s):  
Mar Carmona-Abellan ◽  
Malwina Trzeciak ◽  
Miriam Recio-Fernandez ◽  
Beatriz Echeveste ◽  
Laura Imaz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Stress Testing ◽  
Cardiovascular Response ◽  
Stress Test ◽  
Peak Exercise ◽  
Cardiac Stress ◽  
Cardiac Stress Testing

Abstract Background: Both cerebral vascular disorders and cognitive decline increase in incidence with age. The role of cerebral vascular disease and hemodynamic changes in the development of cognitive deficits is controversial. The objective of this study was to assess cardiovascular response during cardiac stress testing in neurologically asymptomatic individuals who developed cognitive impairment several years after the cardiac stress testing.Methods: This is a retrospective cohort study of patients who underwent cardiac stress testing between January 2001 and December 2010. Patients were followed up until May 2015 and we selected those who developed cognitive dysfunction including dementia, mild cognitive impairment and subjective cognitive decline, after the stress test. Heart rate and blood pressure both at rest and at peak exercise and the mean R-R interval at rest were recorded. For each patient who developed cognitive impairment, we selected one matched control who did not show cognitive decline by the end of the follow-up period.Results: From this cohort of 7224 patients, 371 developed cognitive impairment; of these, 186 (124 men) met the inclusion criteria and 186 of the other patients were selected as matched controls. During follow-up, cognitive impairment appeared 6.2 ± 4.7 years after the cardiac stress test. These patients who subsequently developed cognitive impairment had significantly lower at-rest systolic, diastolic and mean blood pressure than controls (p<0.05). Further, compared with controls, their maximum heart rate was significantly higher at peak exercise and both systolic and diastolic blood pressures increased significantly more during exercise. Conclusion: The results from this study suggest that differences in cardiovascular response to stress are present in the preclinical phase of cognitive decline, serving as a potential risk factor for cognitive impairment. These findings challenge the potential use of blood pressure and heart rate variability at rest and during cardiac stress assessment as a risk factor for cognitive impairment.

Pharmacological stress testing performed by a clinical technologist

2004 ◽  
Vol 25 (4) ◽  
pp. 408 ◽  
Author(s):  
I. Jones ◽  
J. Thornley ◽  
A. Tukan ◽  
A. McCance
Keyword(s):  
Stress Testing ◽  
Pharmacological Stress ◽  
Pharmacological Stress Testing

Ongoing Continuous Quality Improvement Strategy Using Pharmacological Stress with Intravenous Dipyridamole and Pharmacist Intervention to Reduce Suboptimal Exercise Myocardial Perfusion Scans

1994 ◽  
Vol 7 (3) ◽  
pp. 89-92
Author(s):  
Lisa B. Greenstein ◽  
John L. Hatch ◽  
Thomas P. Sherrin
Keyword(s):  
Heart Rate ◽  
Quality Improvement ◽  
Myocardial Perfusion ◽  
Continuous Quality Improvement ◽  
Stress Testing ◽  
Pharmacist Intervention ◽  
Pharmacological Stress ◽  
Exercise Tests ◽  
Continuous Quality ◽  
Pharmacological Stress Testing

Exercise electrocardiogram (ECG) testing in conjunction with radionuclide imaging provides prognostic, diagnostic, and important physiological information regarding the presence of ischemia. However, many patients cannot or will not exercise to 85% of maximal heart rate. When this occurs, potential disparities in regional myocardial perfusion may not be apparent. Pharmacological stress testing with intravenous (IV) dipyridamole provides an alternative method of increasing intracoronary blood flow in these patients and decreasing the incidence of suboptimal exercise myocardial perfusion scans. An ongoing program was begun in 1992 to determine the effect of using pharmacological stress testing with IV dipyridamole (in selected patients) on the incidence of suboptimal exercise myocardial perfusion scans. Myocardial perfusion scans from the months of February 1991 and February 1992 were reviewed. Data collected included demographic variables, heart rate, percent of maximum predicted heart rate, anti-anginal drug therapy, and any underlying conditions that could influence the patient's ability to exercise adequately. There was only a slight reduction in inadequate exercise tests between the two study periods, 30% in February 1991 and 23% in February 1992, without pharmacist intervention. There was an increase in the number of dipyridamole perfusion scans, one (<1%) in February 1991 and 10 (6%) in February 1992. These data were presented to physicians as part of an educational program on the availability and appropriate use of pharmacological stress testing with IV dipyridamole. Several suggestions were made to assist in decreasing the incidence of suboptimal exercise myocardial perfusion scans. The review was repeated in February 1993. There was a further increase in the number of dipyridamole perfusion scans (18, or 11% over previous levels); however, the rate of suboptimal exercise tests remained at 24%. This review offered an easy and unique opportunity for the pharmacy to be involved in multidisciplinary continuous quality improvement with nuclear medicine and cardiology. It is anticipated that with continued education and a change in patient screening procedures, along with the development and use of drug use guidelines, a decrease in the number of suboptimal exercise myocardial perfusion scans may be realized.

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