From the Guidelines
A Lexiscan stress test can be performed with a heart rate in the 110s, but it requires careful clinical consideration and monitoring. According to the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain 1, there is no specific contraindication for Lexiscan based on a heart rate in the 110s. However, the guideline does emphasize the importance of considering contraindications to vasodilator administration and the patient's ability to reach target heart rate.
Key considerations for proceeding with the test include:
- Evaluating the cause of the elevated heart rate, such as anxiety, medication effects, or underlying cardiac conditions
- Ensuring the patient is otherwise appropriate for testing and does not have any contraindications to vasodilator administration
- Continuously monitoring the patient's heart rate, blood pressure, and ECG during the test
- Documenting the elevated baseline heart rate, as it may affect interpretation of the test results
The standard Lexiscan protocol involves a rapid 10-second IV injection of 0.4 mg regadenoson, followed by a saline flush and radiotracer administration 1. If the elevated heart rate is accompanied by symptoms like chest pain or shortness of breath, the physician might consider postponing the test until the patient is more stable. Ultimately, the decision to proceed with the Lexiscan stress test should be made on a case-by-case basis, taking into account the individual patient's clinical status and potential risks and benefits.
From the Research
Lexiscan Stress Testing with Heart Rate in the 110s
- The provided studies do not directly address the safety or efficacy of Lexiscan (regadenoson) stress testing in patients with a heart rate in the 110s 2, 3, 4, 5.
- Regadenoson is a pharmacological stress agent that has been widely used for myocardial perfusion imaging, and its safety and efficacy have been established in various patient populations 2, 3, 5.
- However, the studies do not provide specific information on the use of regadenoson in patients with a heart rate in the 110s.
- One study found that regadenoson stress testing was well-tolerated and safe in patients with pulmonary hypertension, with a mean heart rate increase from 74.6 to 96.3 bpm 4.
- Another study discussed the use of regadenoson as a selective A(2A) agonist, given as an intravenous bolus at a fixed dose, with less undesirable side effects compared to adenosine 5.
- Exercise stress testing is a validated diagnostic test for coronary artery disease, but the provided studies do not address the use of Lexiscan with a heart rate in the 110s in this context 6.