INSTRUCTIONS FOR CARDIOLITE STRESS (MIBI) TEST

Dear:

You have been scheduled for a Cardiolite Stress Test on

Date: ________________ Time: ___________ Location: ________________

When you arrive for your appointment, you will be given an injection of Cardiolite. Cardiolite is a radioactive material used to look at blood flow to your heart muscle. The amount of radiation you will be exposed to is comparable to that from an Xray CAT (CT) scan. Forty-five (45) minutes to one hour after the injection, you will have resting pictures of your heart taken with a special camera.

Immediately following this, you will have a stress test. Cardiolite will again be administered (through an I.V. line) during exercise, and pictures of your heart will once again be taken. Upon completion of these pictures, your test will be finished. The entire procedure will take approximately three (3) hours.

On the day of the test:

• Please refrain from caffeinated drinks for twelve (12) hours prior to your appt.
• You should eat a light meal two hours prior to your appointment time.
• Take all of your usual medications, unless your physician instructed otherwise.
• Wear sneakers or rubbersoled shoes and comfortable, loosefitting clothing.

If you have not previously been a patient in our office, please anticipate arriving here fifteen (15) minutes prior to your appointment to complete the Patient Registration Form.

Check to see if your insurance company requires a referral authorization form. Many HMO's require this prior approval of the test in order for them to pay for it. Check with your primary care physician about whether this has been requested and approved. Without this prior approval, your insurance might not cover the cost of this test, and you will become responsible for all charges.

Please feel free to call our office at (203) 7892272 if you have any questions about this procedure.