Does breast tissue prevent obtaining an accurate result from a nuclear stress test?

I hope you can help me understand the reasoning of a doctor of a friend. She had a treadmill stress test recently, and learned it came back abnormal. I did suggest if they are concerned about the heart muscle and function, that maybe a nuclear stress test could be ordered when she saw her doctor to review the results in person. Her doctor told her that he would not order one because she has breast tissue and that would be in the way of the left wall.

I understand the idea there is attenuation and other tests need to be considered, as I am nuclear medicine tech, but to say no entirely simply because she has breast tissue confuses me. I have had many, very large, and very large breasted, women scanned. Is it normal for a doctor to say that? He left her a little upset (since she does have issues with her ankle, which she has a handicap sign for) with what sounded like an ultimatum, another treadmill stress test or do a heart cath.

I’m just curious about the reasoning than anything else. No medical advice needed, just help in understanding.

Submitted by Amy from Lancaster, Pennsylvania on 04/24/2014

by Atasu Nayak, MD

Thanks for the question. If she has typical angina, then she should go for a coronary angiogram. Otherwise, treadmill nuclear study to rule out significant ischemic heart disease. Please encourage her to consult her cardiologist. Thanks.