The preferred examination is the nuclear medicine cardiac stress & rest Sestamibi combination. The patient undergoes the stress nuclear medicine Sestamibi part of the test following graded treadmill exercise or pharmacologic (Persantine or Dobutamine or Adenosine) stress, which is utilized to induce myocardial ischemia. Then a follow-up rest Sestamibi is performed and the results of both phases of the test are compared. Myocardial perfusion abnormalities that resolve with rest are considered ischemia, while perfusion abnormalities that don't resolve with rest are usually considered areas of infarction. Please note that a Sestamibi examination will also generate a calculated LVEF, but this is not the focus of the examination.