House+Officer

You've gotten a call from the nurses about a patient's study - does the patient need to be NPO? Can you clarify if they need contrast (PO or IV)? Hopefully, you'll find some answers here...

P. thal:
 * Cardiac**
 * 1) NPO after midnight (diabetics may have a light meal, only if needed)
 * 2) No foods with caffeine for 12 hours prior to exam (if abnormal creatinine, caffeine needs to be held at least 24 hours prior to exam) - includes "DECAF" beverages (coffee, tea, cola, etc.)
 * 3) No nitrates 24 hours prior to exam (no nitroPASTE within 48 hours prior to exam) - except sublingual or spray nitrates
 * 4) No aminophylline 24 hours prior to exam (this is the antidote to persantine)
 * 5) Hold hypoblycemic/insuln meds
 * 6) For resting portion: No caffeine or nicotine

Treadmill Stress Test:
 * 1) No beta-blockers for 24 hours prior to exam (remember, the goal is to see an increase in heart rate while on the treadmill)
 * 2) //May// give **short-acting** beta-blockers up to 12 hours prior to this test
 * 3) //If// your patient has ST-depression in the lateral leads secondary to repolarization from LVH, your patient buys themselves a stress ECHO - run this by your attending

Stress ECHO: