What is a Nuclear Stress Test & How Much Does It Cost?

A nuclear stress test is one of the important tests to evaluate the cause of chest pain (angina) and short of breath (dyspnea) at rest or after exercise. Such complaints may be associated with low or high blood pressure, complaints of frequent dizziness and weakness at rest as well as after performing a strenuous activity. Nuclear stress test is also recommended for individuals suffering with heart diseases involving abnormal or irregular heart-beats, cardiomyopathy and heart valve abnormalities. The test is also performed to evaluate status of heart function in patient with history of past heart attack.

The cost of nuclear test is often tied to the importance of test in evaluation of function of heart. The question why the cost of nuclear stress test is often high can be understood by knowing what is a nuclear stress test.

A nuclear stress test is performed in two stages at rest and after strenuous exercise. The aim of the test is to evaluate the working capacity of the heart to supply adequate blood to entire body all the time. The hearts function as a pump to supply blood to entire body depends on quality of heart muscles and heart valves. The normal blood supply to heart itself is extremely important to maintain oxygen supply and nourishment to heart muscles. Heart receives the blood through coronary artery.

Coronary artery diseases such as narrowing of coronary artery restricts the heart blood supply at rest and also during activities. Nuclear stress test evaluates the quality of coronary blood supply to heart and quality of heart muscle contraction. The test also helps to evaluate heart valve function and condition of heart muscles resulting in disease like cardiomyopathy. The test calculates the amount of blood flow to the heart at rest and during activities. The strenuous exercise and dye injection to induce stress test causes increased heart contraction and increased coronary blood flow. Such a dynamic changes of heart muscles contraction and increased heart rate causes increased need of oxygen and nourishment by heart muscles. Average normal person with normal coronary artery blood flow and valve function can compensate the increased heart rate and muscle contractility without causing any symptoms. But, people with coronary artery narrowing (stenosis) and valve disease will have problems.

The average cost of undergoing a nuclear stress test is $1,200 if one is not covered by health insurance policies. The cost can be substantially higher up to $5,000 if one prefers to get the nuclear stress test done at renowned center or center which does not participate with insurance provider. The stress test involving electrocardiogram and echocardiogram can range between $650 to $800. But, the nuclear stress test can range between $ 1,500 to 5,000. Fees for Nuclear stress test includes physician fee, facility fees and cost of material used for test. Average physician fee range is $ 120 to $ 500. Facility fee can be $ 800 to $ 4,600.

The cost of nuclear stress test covers the salary and benefits of several individuals involved in test. The test involves 2 to 3 nurses, physician, electrocardiogram technician, nuclear scan equipment technician and ancillary staffs.

The individual is given following instruction to follow before the nuclear stress test-

• Diet- Individual should not eat or drink for 4 hours prior to test.
• Cloths- Wear loose cloths
• Skin Care- Do not spray lotion, oil or powder over the skin on the day of test. No perfume or deodorant.
• Medications- Take the medications as directed by your physician unless you are instructed not to take the medications.
• Alcohol and Smoking– Avoid drinking alcohol for 2 days and no smoking 4 to 6 hours prior to test.

• Preparation for Test- The nurse will check and document the history, pulse rate, blood pressure, temperature and blood oxygen saturation. The plastic cannula will be inserted into the peripheral vein to establish the intravenous access to inject the nuclear dye for stress test.
• Electrocardiogram- On the day of the nuclear stress test, a nurse or technician will paste patches of electrodes to the chest, legs, and arms. These electrodes are capable of detecting the impulses created in the heart during the exercise activity. The test is known as electrocardiogram. The electrocardiogram gives the evidence of irregular heart beat and past heart attack.

Nuclear stress test- The nuclear stress test consists of two phases:

• First Phase- In the first phase of nuclear stress test, patient is advised to lie flat on the bed. The phase is known as resting phase when heart is not stressed by exercise or injection of dye. During resting phase patient’s heart is monitored by electrocardiogram and radioactive dye is injected in the vein. The heart is then scanned by a scanner which detects radioactive dye. The images of the scan studied to evaluate the heart blood flow. Normal blood flow indicated normal heart contractility, heart beats suggesting heart is receiving the normal amount of oxygen and nutrients at appropriate levels.
• Second Phase- During the second phase of nuclear stress test, the participant will run on the inclined treadmill. The speed as well as inclination of the treadmill is slowly increased depending on tolerance and development of uncomfortable symptoms. In few cases, patient is advised to discontinue the exercise if patient complaints of chest pain and dizziness. If patient is asymptomatic then speed and inclination is slowly increased to create optimum work load for heart. Occasionally, patient is unable to walk or run on treadmill or ride on stationary bike. In such cases patient is given an injection through intravenous access to increase heart rate to optimum level suitable for patient’s age. The increased heart rate either by exercise or drug induced results in extra work by heart muscle. Heart muscles have to contract to optimum level to pump adequate amount of blood to entire body to provide oxygen and nutrients to organs and muscles. In doing so heart rate and blood pressure increases. Patient complaints of chest pain and dizziness if blood flow to heart is compromised because of narrowed coronary arteries. In such cases the stress test is discontinued and test is considered failed test. It can even continue further depending on the tolerance shown by the participant. Generally, the doctor asks the patient to stop the activity when patient complaints of chest pain, weakness or dizziness.

The cardiologist will study and evaluate the findings of electrocardiogram, echocardiogram and nuclear scan studies during first and second phase. The diagnosis depends on careful evaluation of prior history of cardiac symptoms, history of symptoms during the study and abnormal findings of nuclear stress test. The nuclear stress test also helps to evaluate heart valve disease and cardiomyopathy.

Cardiologist may suggest further investigation like coronary angiogram or cardiac CT studies. The abnormal cardiac stress test resulting in symptoms like chest pain and dizziness often suggest something is wrong with heart and it’s blood supply. The study may not conclude which branch of the heart blood vessel is blocked or how severe is heart valve damage. In such cases patency of coronary artery is evaluated by angiogram study. If diagnosis is conclusive and does not need surgical treatment then cardiologist will prescribe appropriate medication to improve heart blood flow.

Overall the nuclear stress test is the most important test to evaluate heart function and need careful patient evaluation as well as close monitoring during test incurring often higher cost.

Also Read:

• Do I Need a Stress Test?
• What Does It Mean To Have An Abnormal Stress Test?
• How Long Does A Nuclear Stress Test Take?
• How Long Will You Be on a Treadmill for a Stress Test?
• Can You Eat or Drink before a Stress Test?