Cardiology associates

Dennis L. Brooks, M.D. Siegfried O. Storz, M.D., F.A.C.C. Jeffrey C. Brackett, M.D., F.A.C.C. George D. Mitchell, M.D., F.A.C.C. Alon A. Steinberg, M.D., F.A.C.C. Shaun T. Patel, .M.D., F.A.C.C. Douglas S. Wilkinson, M.D., F.A.C.C. PRACTICE LIMITED TO CARDIOLOGY
Patient Preparations for Myocardial Perfusion Studies
Patient: _____________________________________ Location: 1701 Solar Dr. Suite 150
Oxnard, CA 93030
APPOINTMENT DATE: ______________________________ Phone #: (805) 278-4020
TIME: ___________am / pm
Preparations for the test: (Your test will take approximately 3 hours)

Nothing to eat or drink after:
• Do not eat or drink anything 4 hours prior to your appointment. □ 4:00am □ 6:00am □ 8:30am
**Bring a snack & bottled water to your appointment**
• Do not smoke for 24 hours prior to your appointment.

• Do not eat or drink any caffeinated foods or beverages (decaffeinated coffee must be avoided) or take
caffeine-containing medications for 24 hours before your test. Caffeine can be found in coffee, tea, chocolate,
cold or certain migraine preparations. (Example: Excedrin). Note: Decaffeinated products also
contain a small amount of caffeine and may not be consumed. If you have diabetes, take your diabetic medi-
cation only if you will be eating immediately afterwards. Wear comfortable clothes and rubber soled shoes or
sneakers.
For Adenosine (Medication) Stress Test:
• You may take all your heart and blood pressure medications.
For Exercise Treadmill Stress Test:
• Do not take any Beta-Blockers 48 hours prior to your appointment* • Do not take any Calcium Channel Blockers 24 hours prior to your appointment* *See the reverse side of this sheet for the most frequently ordered Beta-Blockers and Calcium Channel Blockers.
NO Theophylline / Theo-Dur (24 hours) with referring MD approval.
NO lotions, powders, body oils or soaps w/conditioners.
Patients should wear loose comfortable clothing with walking shoes.
Please do not wear any jewelry.
It is very important that each patient arrives on time.
Important note:
It is extremely important that each of you follow the preparations for this examination. If preparations are not fol-
lowed or if you do not cancel your appointment at least 24 hours prior you may be required to pay the cost of the
Radiopharmaceutical which is ordered specifically for you, our cost is about $200 per patient.
If you have any questions or need clarifications please call us at (805) 278-4020
♦You will have a Questionnaire & Consent Form
to fill out the day of your appointment♦

Source: http://cardiacadvantage.com/images/uploaded/camginc/NewMPSInstructions.pdf

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