At a glance
A myocardial perfusion scan is a nuclear medicine imaging test that shows how well blood flows through the heart muscle both at rest and under stress.
A small amount of a radiotracer (a mildly radioactive substance) is injected into a vein. The tracer travels through the bloodstream and is absorbed by heart muscle cells in proportion to how much blood they are receiving. A special camera called a gamma camera then detects the radiation and produces detailed images. Areas of the heart that receive too little blood appear as darker patches on the images, helping doctors pinpoint blockages or damage without surgery.
Medical Condition
Doctors order a myocardial perfusion scan when they need to map blood supply to the heart muscle, assess known or suspected coronary artery disease (narrowing of the heart's own blood vessels), or evaluate how the heart is functioning after a previous heart attack or procedure.
- Chest pain or pressure that has not yet been explained
- Suspected coronary artery disease (CAD), where fatty plaques narrow the arteries feeding the heart
- Assessment before major non-cardiac surgery in a patient with heart risk factors
- Evaluation after a heart attack (myocardial infarction) to see how much muscle survived
- Monitoring after bypass surgery or stent placement to check whether the treatment is still working
- Unexplained shortness of breath that may have a cardiac cause
- Abnormal results on an exercise stress test that need further investigation
The scan is not suitable for every patient. Doctors usually consider alternative imaging or adjust the protocol for people in the following situations.
- Pregnancy, because even low radiation exposure is avoided during fetal development
- Severe kidney impairment in protocols that require a contrast agent alongside the scan
- Inability to tolerate the pharmacological stress agent used when a patient cannot exercise on a treadmill
- Recent significant radiation exposure that makes adding more exposure inadvisable
Risks & Complications
A myocardial perfusion scan is a low-risk diagnostic test; the main considerations involve the small radiation dose and the stress portion of the exam, not the imaging itself.
- Low-level radiation exposure from the radiotracer, comparable to some routine X-ray series; the tracer clears from the body within hours to a day
- Mild allergic reaction to the radiotracer, such as brief skin flushing or itching, which usually resolves quickly without treatment
- During pharmacological stress (medication used to mimic exercise): temporary chest tightness, flushing, headache, or a brief drop in blood pressure
- Temporary heart rhythm changes during the stress phase, monitored continuously by the clinical team
- Very rarely, a more significant cardiac event during the stress portion in patients with severe underlying disease; the test is always performed with resuscitation equipment nearby
- Slight bruising or soreness at the injection site
Preparation & Procedure
Preparation for a myocardial perfusion scan usually begins the day before and covers what you eat and drink, medications, and lifestyle habits.
You will be asked to avoid caffeine (coffee, tea, energy drinks, chocolate, and some sodas) for at least 24 hours before the test, because caffeine interferes with the stress medications used. Most hospitals also ask you to stop eating and drinking, except plain water, for four to six hours before the scan. Your doctor will give specific instructions about which regular medications to continue and which to pause, particularly beta-blockers (drugs that slow the heart rate) and certain heart medications. Smoking on the day of the test is also typically not allowed.
Before the scan is scheduled, the nuclear medicine team usually reviews recent blood tests, an electrocardiogram (EKG, a recording of the heart's electrical activity), and sometimes a recent echocardiogram (ultrasound of the heart). Kidney function tests may be checked if a contrast agent is part of the protocol.
The procedure itself generally follows these steps, though the exact order and details vary between hospitals and individual patient needs.
- A small intravenous (IV) line is placed in a vein in your arm.
- The radiotracer is injected through the IV line. You wait, usually 30 to 60 minutes, while the tracer is absorbed by the heart muscle.
- The gamma camera takes the first set of images with you lying still on the scanning table. This is the resting scan.
- The stress phase follows. If you are physically able, you walk or jog on a treadmill. If not, a medication is given through the IV to widen the coronary arteries and mimic the effect of exercise on blood flow.
- A second dose of radiotracer is injected at peak stress.
- After a further waiting period, the gamma camera takes a second set of images. This is the stress scan.
- The two sets of images are compared to identify areas where blood flow changes between rest and stress.
Aftercare
Recovery from a myocardial perfusion scan is straightforward for most patients because no incision is made and no sedation is given; the main aftercare involves helping the body clear the radiotracer and following any activity guidance from the stress phase.
- You are usually observed briefly in the nuclear medicine department after the scan to confirm you feel well before leaving.
- Drinking plenty of water in the hours following the test helps the kidneys flush the radiotracer from the body faster.
- If a pharmacological stress agent was used, staff will monitor you for a short time until any temporary effects such as flushing or chest tightness have fully resolved.
- Most patients can resume normal eating and most daily activities the same day.
- Avoid prolonged close contact with pregnant women and young children for the rest of the scan day, as a routine precaution with any radiotracer procedure.
- The IV line is removed before you leave; keep the small dressing dry for a few hours.
- A nuclear medicine physician and your cardiologist will review the images, which usually takes one to several days. Results are communicated through your referring doctor.
- A follow-up appointment to discuss the findings and decide on next steps is typically arranged by your cardiologist.
Cost & What Determines It
The price of a myocardial perfusion scan varies widely depending on where it is performed, how technically demanding the individual scan is, and what the hospital includes in its quoted fee.
- Type of stress protocol used: treadmill exercise versus pharmacological stress agents adds different costs for medication and monitoring time
- Imaging technology: single-photon emission CT (SPECT) is the standard, while newer cardiac PET (positron emission tomography) scanners cost more to operate and typically carry a higher fee
- Hospital class and country: a university hospital or internationally accredited centre in a high-income country prices this service differently from a regional hospital in a developing country
- Radiotracer selection: different tracers have different production costs, and some require same-day on-site preparation
- Cardiologist and nuclear medicine physician fees: these are often billed separately from the facility fee
- Additional monitoring: EKG recording throughout the stress phase, blood pressure monitoring, and nursing time
- Any extra tests ordered at the same visit, such as a full echocardiogram or blood panel
- Whether a radiologist report is included or charged as a separate reading fee
A hospital package for a myocardial perfusion scan typically covers the nuclear medicine suite time, the radiotracer dose, gamma camera imaging, basic EKG monitoring during stress, and a written report from the nuclear medicine physician. Items often billed separately include the cardiologist consultation, any pharmacological stress medication given as a named prescription, additional blood tests, and any follow-up imaging that results from the findings.
BPJS Kesehatan does not cover medical procedures performed abroad, and most Indonesian private health insurance policies also exclude overseas treatment. Patients who travel for this scan usually pay out of pocket or rely on an international insurance plan that explicitly covers treatment outside Indonesia. Before travelling, ask the hospital for a written cost estimate that lists each component separately so there are no unexpected charges on arrival or after the scan.
Frequently Asked Questions
Does a myocardial perfusion scan hurt?
The scan itself is painless. You will receive an injection of a small amount of radioactive tracer (a mildly radioactive substance that helps the camera see blood flow in your heart), which feels like any normal injection. If a stress test is part of the procedure, your doctor may ask you to walk on a treadmill or give you a medicine that makes your heart beat faster, which can cause temporary flushing or mild chest tightness.
How do I prepare for a myocardial perfusion scan, and do I need to fast?
Most hospitals ask you to avoid food, caffeine, and certain heart medicines for several hours before the scan. Your care team will send you a checklist specific to your case, so follow those instructions rather than general advice. Wear comfortable shoes, because a treadmill stress test may be part of the appointment.
How long does a myocardial perfusion scan take?
The full appointment usually takes between three and five hours, though the actual imaging sessions are much shorter. The extra time comes from waiting for the tracer to reach your heart muscle, and sometimes a second round of images is taken after rest so the doctor can compare the two sets of pictures.
How much does a myocardial perfusion scan cost?
The cost depends on several factors, including whether both stress and rest images are needed, the class of hospital or imaging centre you choose, and the type of camera used (SPECT or PET, which are two different imaging technologies). A written estimate from the hospital you are considering is the most reliable way to know what you will actually pay.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
