Indications and Contraindications to Stress Cardiac Perfusion Imaging

Distilled from the American Society of Nuclear Cardiology guidelines:

The indications for the various stress methods are the same, with adenosine/dipyridamole allowing for evaluation of very early MI and better evaluation of patients with baseline ECG abnormalities (LBBB, Wolff-Parkinson-White syndrome, and permanent ventricular pacing). Dobutamine is reserved for patients who can't have treadmill or adenosine/dipyridamole studies.

The absolute contraindications for adenosine and dipyridamole include active asthma (controlled asthma should be OK) and second- and third- degree AV block (only a relative contraindication in exercise stress). Unstable angina is an absolute contraindication to treadmill and dobutamine stress.