Dobutamine Stress Echocardiogram (dobutamine echo, pharmacological echocardiogram)
Definition:
An echocardiogram (often called "echo" or “echocardiography”) is a graphic outline of the heart's movement , valves and chambers. The dobutamine stress echo test involves infusing a medication through an intravenous (IV) line, called dobutamine, while you are closely monitored. The medication stimulates your heart and makes it "think" it is exercising. The test is used to evaluate your heart and valve function when you are unable to exercise on a treadmill or stationary cycle.
Echocardiography is often combined with Doppler ultrasound and color Doppler to evaluate blood flow across the heart’s valves.
Your doctor uses dobutamine stress echo to:
- Determine how well your heart tolerates stress or exertion
- Evaluate the function of your heart and valves
- Evaluate the effectiveness of your cardiac treatment plan
- Determine the likelihood of having coronary artery disease and the need for further testing
To prepare for echocardiography:
- DO NOT eat or drink anything except water for four hours before the test. DO NOT drink or eat caffeine products (cola, Mountain Dew, chocolate products, coffee or tea) for 24 hours before the test. Caffeine will interfere with the results of the test.
- Ask your doctor what medications should be taken on the day of your echocardiography test. DO NOT take the following heart medications on the day of the test unless your physician tells you otherwise or if the medication is needed to treat chest discomfort:
- Beta blockers [for example: atenolol (Tenormin), metroprolol (Lopressor, Toprol), Propranolol (Inderal)]
- Isorbide dinitrate (for example: Isordil, Sorbitrate)
- Isosorbide mononitrate (for example: Ismo)
- Nitroglycerin (for example: Deponit, Nitrostat)
Your physician may also ask you to stop taking other heart medications on the day of the test. If you have questions about your medications — ask your physician. Do not stop any medication without first talking with your doctor.
Since many over-the counter medications contain caffeine (such as diet pills, No Doz, Excedrin and Anacin), DO NOT take any over-the-counter medication that contains caffeine for 24 hours before the test. Ask your physician, pharmacist or nurse if you have questions about other mediations that may contain caffeine.
- If you have diabetes and take medications to manage your blood sugar, ask your physician how to adjust your medications the day of your test. Do not take your diabetes medication and skip a meal before the test. If you own a glucose monitor, bring it with you to check your blood sugar levels before and after your echocardiography test. If you think your blood sugar is low, tell the lab personnel immediately. Plan to eat and take your blood sugar medication after your test.
- You can wear whatever you like. You will need to change into a hospital gown to wear during the procedure. Do not bring valuables.
What to expect:
- Before the test, a a cardiac sonographer (an allied health professional who has been trained specifically to perform ultrasound examinations), nurse or physician will explain the procedure in detail, including possible complications and side effects. They will be available to answer any questions you may have.
- You will be given a hospital gown to wear.
- First a sonographer will gently rub ten small areas of your chest, and place small sticky electrode patches to these areas. The electrodes are attached to an electrocardiograph (ECG) monitor, which charts your heart’s electrical activity during the test.
- An intravenous (IV) line will be inserted into a vein in your arm so the dobutamine medication can be delivered directly into your bloodstream. The cardiac sonographer will perform a resting ECG, measure your heart rate and take your blood pressure.
- The sonographer will ask you to lie on your left side on an exam table so he or she can perform a resting echo. The sonographer will place a wand (sound-wave transducer) on several areas of your chest. The wand will have a small amount of cool gel on the end, which will not harm your skin. This gel helps get clearer pictures. This should not hurt.
- The physician or nurse will administer the dobutamine medication into the IV while the cardiac sonographer continues to obtain echo images.
- The medication will cause your heart to react as if your were exercising: your heart rate will rise and you may feel it beating more strongly. It may cause a warm, flushing feeling and, in some cases, a mild headache.
- At regular intervals, the lab personnel will ask how you are feeling, and will check your EKG, blood pressure and heart rate. Please tell them if you feel chest, arm, or jaw pain or discomfort; shortness of breath, dizziness; lightheadedness; or or irregular heartbeats immediately. This procedure is usually well tolerated, but occasionally there are complications. Please consult the health care provide performing the test about the associated risks.
- The lab personnel will watch for any symptoms or changes on the ECG monitor that suggest the test should be stopped.
- The IV will be removed from your arm once all of the medication has entered your bloodstream. As soon as your heart rate is adequately high, echo pictures are taken.
- The dobutamine stress echo takes about 60 minutes. The actual infusion time is usually 15 minutes. You should also plan to stay in the waiting room for at least 30 minutes after completing the procedure, or until all of the symptoms you have experienced are resolved.
- After the cardiologist reviews your test, the results will go into your electronic medical record. Your physician will have access to the results and will discuss them with you.
Ask your doctor if you have any questions about the dobutamine stress echo.
Find a Cleveland Clinic Heart and Vascular Institute doctor who performs this procedure
