American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be considered when using vasodilators for nuclear stress testing?

1. A history of hypertension

2. A history of asthma

3. A history of COPD

4. A previous heart attack

The correct answer is: A history of COPD

When using vasodilators for nuclear stress testing, considering a history of COPD (Chronic Obstructive Pulmonary Disease) is crucial. Vasodilators, such as adenosine or regadenoson, can cause bronchoconstriction as a side effect due to their influence on adenosine receptors. In patients with COPD, this bronchoconstriction could exacerbate respiratory symptoms, leading to complications during the stress test. In contrast, a history of hypertension, asthma, or a previous heart attack does not pose as significant a risk when using vasodilators. Although asthma is also relevant, COPD specifically highlights the risk of worsened pulmonary function due to ongoing airway obstruction and inflammatory processes already present in these patients. Therefore, understanding the potential impact of vasodilators on respiratory function in patients with COPD is vital for safe and effective stress testing.