3*FOR DYNAMIC EXERCISE TO BE EFFECTIVE, MAXIMUM WORK MUST BE ACHIEVED*
*DURING COLD PRESSOR AND ISOMETRIC HAND GRIB STRESS, THE HEMODYNAMIC RESPONSE DECAYS OVER 4 MINUTES, AND THEREFORE COLLECTION OF DATA MUST BE COMPLETED RAPIDLY*
*IF THERE IS NO RISE IN BLOOD PRESSURE WITH COLD PRESSOR OR ISOMETRIC HAND GRIB STRESS, AND THE TEST RESULT IS NEGATIVE, THEN THIS RESULT SHOULD BE CONSIDERED UNRELIABLE*

4*AN EXERCISE TEST FOR 201Tl SCAN DIFFERS FROM A DIAGNOSTIC EXERCISE TEST; THE END POINT IS NOT EVIDENCE OF ISCHAEMIA, BUT WHEN THE GREATEST AMOUNT OF WORK HAS BEEN ACHIEVED WITHIN THE LIMITS OF SAFETY*
*SUBMAXIMAL STRESS WILL RESULT IN A FALSE NEGATIVE RESULT IN SOME PATIENTS WITH CORONARY ARTERY DISEASE*

5*PATIENTS MAY NOT BE ABLE TO ACHIEVE ADEQUATE EXERCISE LEVELS OR PULSE RATES BECAUSE OF:
a. LEG CLAUDICATION
b. PHYSICAL INABILITY, eg ONLY ONE LEG
c. UNWILLINGNESS TO MAKE THE PHYSICAL EFFORT NECESSARY
d. UNFAMILIARITY WITH A BICYCLE IF A BICYCLE ERGOMETER IS USED*

*IN THESE CIRCUMSTANCES USING DIPYRIDAMOLE STRESS INSTEAD OF EXERCISE WILL GIVE BETTER RESULTS*
*DOPAMINE AND ADENOSINE MAY ALSO BE USED AS PHARMACOLOGICAL STRESS AGENTS*

6*THE RIGHT VENTRICLE WILL BE EASILY SEEN ON THE 201Tl STUDY WHEN THERE IS :
-RIGHT VENTRICULAR HYPERTROPHY
-PULMONARY ARTERIAL HYPERTENSION
-GLOBAL DECREASE IN LEFT VENTRICULAR UPTAKE*

7*ADEQUATE EXERCISE AND PULSE RATE RESPONSE ARE NECESSARY TO INCREASE THE MYOCARDIAL BLOOD FLOW TO NORMAL MYOCARDIUM SUFFICIENTLY TO BRING OUT THE CONTRAST BETWEEN NORMAL AND ABNORMAL MYOCARDIUM, WHERE THE BLOOD FLOW CANNOT INCREASE BECAUSE OF THE STENOSED SUPPLYING VESSEL*
*DECREASED TRACER UPTAKE AT REST IS ALMOST ALWAYS DUE TO AN INFARCT, BECAUSE, EVEN WITH SEVERE ISCHEMIC LESIONS, THE CORONARY BLOOD FLOW IS RARELY SIGNIFICANTLY DECREASED AT REST*
*A 'REVERSIBLE' DEFECT HAS A HIGH SPECIFICITY FOR MYOCARDIAL ISCHAEMIA INDUCED BY OCCLUSIVE CORONARY DISEASE. HOWEVER, 201Tl UPTAKE IN THE MYOCARDIUM IS PARTIALLY CELL-DEPENDENT AND MAY, ON OCCASION, BE SEEN IN OTHER DISORDERS SUCH ASMYOCARDITIS*
*REDISTRIBUTION IMAGE AT 3 HOURS AFTER STRESS STUDY IS COMPARABLE, BUT NOT EXACTLY THE SAME AS, A REST IMAGE. DECREASED UPTAKE ON THE REDISTRIBUTION IMAGE DOES NOT ALWAYS SIGNIFY AN INFARCT,ie THE FIXED LESION MAY BE OVER REPORTED*

8*30-50% OF APPARENTLY 'FIXED' DEFECTS WILL REVERSE FOLLOWING REINJECTION OF 201Tl ON DELAYED IMAGING*

9*IT IS ESSENTIAL TO BE SURE THAT MAXIMUM EXERCISE IS ACHIEVED IF DYNAMIC EXERCISE IS USED, OR THAT THERE IS AN ADEQUATE HEMODYNAMIC RESPONSE TO ISOMETRIC HAND GRIB OR COLD PRESSOR, TO AVOID FALSE NEGATIVE STUDIES*

10*ABSENT 201Tl UPTAKE ON A REST IMAGE MAY BE DUE TO EITHER RECENT OR OLD INFARCTION WHICH CANNOT BE DIFFERENTIATED*

11*THE CLINICAL INDICATIONS FOR 99mTc PYROPHOSPHATE IMAGING ARE FEW, BUT IN CERTAIN CLINICAL CIRCUMSTANCES WHERE THE ECG IS EQUIVOCAL, PYROPHOSPHATE IMAGING MAY PROVE USEFUL*

12*EXERCISE ECG STUDIES ARE USUALLY NON-DIAGNOSTIC WHEN THERE IS A SIGNIFICANT CONDUCTION DEFECT PRESENT*

13*A COMBINATION OF DIPYRIDAMOLE AND LIMITED STRESS SUCH AS ISOMETRIC HAND GRIB OR WALKING ON THE SPOT WILL INCREASE THE SENSITIVITY OF THE STUDY*

14*SENSITIVE OF PYROPHOSPHATE IMAGING IS MAXIMUM BETWEEN 1 AND 3 DAYS*

15*A 'DONUT' APPEARANCE ALWAYS INDICATES A LARGE TRANSMURAL INFARCT*

16*FOUR VIEWS ARE ESSENTIAL FOR A COMPLETE EVALUATION OF AN EXTENSIVE WALL MOTION ABNORMALITY, AND OCCASIONALLY SMALL ANEURYSMS CAN BE MISSED ENTIRELY IF ONLY ONE VIEW IS USED*

17*A FULL ASSESSMENT OF THE FUNCTIONAL EFFECT OF AN ANGIOPLASTY CAN ONLY BE MADE IF A PRE-ANGIOPLASTY STUDY IS ALSO UNDERTAKEN*

18*THESE CHANGES WITH STRESS ARE NON-SPECIFIC, AND MAY BE SEEN IN PRACTICALLY ANY MYOCARDIAL DISORDER*
*SLIGHT LEFT VENTRICULAR DILATATION IS COMMONLY SEEN IN OLDER PATIENTS. HOWEVER, A SIGNIFICANT DROP IN EJECTION FRACTION (>5%) DOES NOT NORMALLY ACCOMPANY THIS*

19*FOCAL WALL MOTION ABNORMALITIES ARE MUCH MORE SPECIFIC FOR CORONARY ARTERY DISEASE THAN GENERALIZED GLOBAL DETERIORATION WITH STRESS*

20*A MYOCARDIAL INFARCT WILL PRODUCE A FOCAL WALL MOTION ABNORMALITY AT REST, EITHER HYPOKINESIA OR AKINESIA, AS OPPOSED TO AN ISCHEMIC AREA, WHICH WILL ONLY APPEAR AS A WALL MOTION ABNORMALITY UNDER CONDITIONS OF HEMODYNAMIC STRESS*

21*WITH SEVER IMPAIRMENT OF VENTRICULAR FUNCTION, STRESS STUDIES DO NOT MATERIALLY CONTRIBUTE TO THE ASSESSMENT OF THE PATIENT, AND MAY BE DANGEROUS*

22*THE EJECTION FRACTION MAY NOT RAISE IN RESPONSE TO EXERCISE IN PATIENTS WITH AORTIC VALVE DISEASE. A FALL IN EJECTION FRACTION, HOWEVER, IS ABNORMAL AND INDICATES EARLY VENTRICULAR DECOMPENSATION*
*GATED BLOOD POOL STUDIES PROVIDE A NON-INVASIVE METHOD OF ACCURATELY FOLLOWING PATIENTS WITH AORTIC VALVE REGURGITATION, AND ASSIST IN DETERMINING THE OPTIMUM TIME FOR SURGERY*

23*A PRETREATMENT ASSESSMENT OF VENTRICULAR FUNCTION IS REQUIRED TO IDENTIFY PRETREATMENT DYSFUNCTION*
*CARDIOTOXIC EFFECTS MAY BE FOCAL OR GLOBAL*

24*THE ABSENCE OF VISUALIZATION OF A NEGATIVE LEFT VENTRICLE MAY BE SEEN:
-WITH RIGHT TO LEFT SHUNTING
-WITH A LARGE RIGHT VENTRICLE
-WITH A SMALL LEFT VENTRICLE
-WITH CHILDREN LESS THAN TWO YEARS OLD, WHEN THE RESOLUTION MAY BE INADEQUATE TO DISPLAY THE PHOTON-DEFICIENT AREA OCCUPIED BY THE LEFT VENTRICLE*

25*THE MAIN COMPLICATIONS ARISING FROM SURGICAL CORRECTION OF TRANSPOSITION OF THE GREAT VESSELS ARE:
-OBSTRUCTION TO THE VENOUS RETURN BY THE BAFFLE
-INADEQUATE DIVERSION OF BLOOD BY THE BAFFLE
-FAILURE OF THE RIGHT VENTRICLE, WHICH IS ACTING AS THE SYSTEMIC VENTRICLE*