Dobutamine Stress Test

A dobutamine (pronounced “doh-BYOO-tah-meen”) stress test is a way for your healthcare provider to see how your heart works while under stress. It’s also called a dobutamine stress echo (DSE). It’s an option for when you can’t exercise on a bike or treadmill for a stress test. A healthcare provider gives you medicine through an IV that makes your heart beat faster and work harder, as if you were exercising. At the same time, they take ultrasound images of your heart (an echocardiogram) after each increase in the medicine.

This test helps your healthcare provider check:

• Blood supply to your heart muscle: Blockages in your coronary arteries can lead to ischemia, or reduced blood flow to your heart. A DSE can reveal which areas are affected.
• Your heart’s pumping action: This test can show how well your heart chambers relax to fill with blood and squeeze to push blood out.
• Heart valve function: Your heart valves keep blood moving in the right direction through your heart. This test can show if a valve has trouble opening or closing as it should.
• Your heart’s structure: Your heart has many parts that work together. A DSE can show if any of these parts are damaged and can’t work right.

Why is it done?

Healthcare providers perform dobutamine stress tests for several different reasons. These include finding the cause of unexplained symptoms, assessing your risk of a heart attack and learning if you’re at risk for heart-related complications before you have a major surgery. 

A DSE can help diagnose or monitor:

• Narrowed or blocked coronary arteries (coronary artery disease)
• Heart issues you were born with (congenital heart disease)
• Heart muscle disease (cardiomyopathy)
• Problems with your heart’s pumping ability (heart failure)
• Narrowed or leaky heart valves (valve disease)
• High blood pressure in your lung arteries (pulmonary hypertension)

How does the test work?

A dobutamine stress test is an alternative to an exercise stress test. That means you don’t use a bike or treadmill. Instead, a healthcare provider gives you medicine called dobutamine through an IV. The medicine makes your heart work harder. Your heart rate will go up, just like if you were exercising. But you’re lying down, rather than moving.

Your provider will gradually increase the dose of medicine as the test goes on. They’ll take pictures of your heart every few minutes. They’ll also monitor your vital signs, like your blood pressure, pulse and blood oxygen level.

The test will end if any of the following happen:

• You reach the target heart rate that your provider sets for you
• Your blood pressure gets too high or too low
• Your heart rate or rhythm is abnormal
• You say you want the test to end

You can expect the entire appointment to take about one hour. But you’ll only be receiving dobutamine for about 10 to 15 minutes.

A cardiac sonographer performs the ultrasound imaging while a physician supervises the test.

How do I prepare?

Certain substances and medications can interfere with the test and give you false results. Your healthcare provider will tell you what to do or avoid before the test so it works how it should. Be sure to closely follow their guidance and ask if anything is unclear.

In general, you may need to:

• Fast. This means you don’t have any food or drinks other than water. You may need to start fasting four hours before the test.
• Stop smoking. Don’t smoke on the day of your test.
• Avoid caffeine. Don’t have any caffeine for 24 hours before the test. Caffeine is in coffee, tea, soda, energy drinks, chocolate, “decaf” products and even some medicines.
• Stop taking certain medicines. Never stop taking any on your own. Your provider will tell you if you should stop taking any on the day of your test or 24 hours beforehand. Bring all of your medicines with you to the test.

If you have diabetes, your provider will also give you special instructions. These include when to take insulin and other medicines. They’ll also explain how to time any meals or snacks. Bring your glucose monitor with you to the test. You’ll need to check your blood sugar levels before and after the test. Tell someone at the lab right away if your blood sugar is low.

If you have a pacemaker or defibrillator (ICD), your healthcare provider must check it before your test. Call your provider to set up a time.

What can I expect during the test?

To perform a dobutamine stress test, your sonographer will:

1. Connect you to an EKG. Your provider will place small, sticky patches (electrodes) on your chest. These connect to a monitor that tracks your heart rate and rhythm.
2. Put a blood pressure cuff on your arm. This measures your blood pressure during the test.
3. Put ultrasound gel on your chest. This might feel cool. It helps transmit sound during the echo portions of the test.
4. Take a resting EKG and echo. These initial tests show what’s normal for you when you’re not stressing your heart. You’ll lie still and won’t feel anything from the EKG. For the echo, your provider will place a wand-like device (transducer) on different areas of your chest.
5. Start an IV line. Your provider will insert a thin, flexible tube in a vein in your arm.
6. Inject dobutamine. They’ll use the IV to start giving you dobutamine. The dose will gradually increase every few minutes. The medicine makes your heart react as if you were exercising. You may feel your heart rate go up. You may feel warm, flushed or have a mild headache.
7. Take pictures of your heart. After each dose of medicine, your provider will place the wand on your chest. This lets them collect more images.
8. Monitor symptoms. Your provider will watch the EKG and blood pressure monitors. They’ll also ask how you’re feeling at various points. Speak up any time if you have pain or discomfort in your chest, arm or jaw. Also, say if you’re dizzy or short of breath.
9. End the test. After collecting images, your provider will remove the IV from your arm. They’ll continue monitoring your vital signs until they return to normal. 

Is a dobutamine stress test safe?

This test is safe for most people. Your healthcare provider will review your health history beforehand. They won’t do the test if certain health conditions make it unsafe for you. Be sure to ask your provider about all possible complications and the chances of them happening.

Let your provider know if you’re pregnant or could be. They may suggest another type of test instead.

About 1 in 500 people have serious complications from a dobutamine stress test, like:

• Heart attack
• Sustained ventricular tachycardia
• Ventricular fibrillation

You’re closely monitored during and after the test. Providers are prepared to treat these issues right away if they do occur.

What can I expect after the test?

Your provider will monitor you for a short period after the test ends. Your heart rate and blood pressure should gradually go back to normal. Tell your provider if you feel any symptoms.

Dobutamine can cause a slight drop in blood pressure. So, you should arrange for someone to drive you home from your test.

What type of results do you get?

There are three main types of results:

• Positive (abnormal): Your heart doesn’t respond normally to stress due to reduced blood flow or another issue.
• Negative (normal): Your heart responds normally to stress.
• Inconclusive: Your provider can’t make a diagnosis from the results. While the reasons can vary, this is usually due to the heart not responding adequately or not reaching a target heart rate. In this situation, you may need additional testing.

The provider who ordered the test will go over the results with you. They’ll explain any next steps, like treatments or further testing. Contact your provider if you don’t hear from them within one week of your test.