Dobutamine Stress Echocardiogram

Overview

What is a dobutamine stress test?

A dobutamine (pronounced “doh-BYOO-tah-meen”) stress echocardiogram is a test to see how your heart works while under stress.

An echocardiogram is a heart test that uses ultrasound vibrations to make an outline of your heart’s movement. The vibrations “echo” from your heart’s structures.

Unlike an exercise stress test, you don’t use a treadmill or stationary bike to increase your heart rate. During a dobutamine stress test, you receive a medication called dobutamine, which stimulates your heart just like exercise does. This test allows healthcare providers to see how your heart works under the stress of physical activity.

A dobutamine stress test can show:

  • Problems with your heart muscle or valves.
  • Proper (or improper) blood supply to your heart muscle.
  • Electric stability of your heart when it’s resting and under stress.

When is a dobutamine stress echocardiogram performed?

If you can’t exercise on a treadmill or stationary cycle to get your heart rate up, healthcare providers use dobutamine. The test can:

  • See how well your heart can handle activity.
  • Figure out your chances of having coronary artery disease.
  • Figure out the severity of heart valve disease.
  • Check how well your heart works before heart surgery.
  • Check how well your heart treatment plan is working.

Who performs a dobutamine stress echo test?

A physician supervises the testing area. A cardiac sonographer performs your dobutamine stress echocardiogram.

Test Details

How does a dobutamine stress echo test work?

Here’s what you can expect during your dobutamine stress echocardiogram:

  1. Electrode placement: A cardiac sonographer gently sticks electrodes (small, flat patches) on 10 areas of your chest. They attach the electrodes to an electrocardiogram (EKG) monitor that measures your heart’s electrical activity during the test.
  2. Resting EKG: Before you get any dobutamine, the sonographer performs a resting EKG. You lie on your left side on a table. The sonographer places a wand (transducer) on your chest to view your heart’s movement. They take images of your heart throughout the test.
  3. IV line: The sonographer inserts an intravenous (IV) line into a vein in your arm to inject the dobutamine into your bloodstream. You may feel a sharp pinch as they insert the IV.
  4. Dobutamine injection: A healthcare provider delivers the dobutamine medication into the IV. The technician continues to move the transducer to get echo images. The medication causes your heart to react as if you were exercising. Your heart rate goes up. You may feel your heart beating stronger than usual. You may feel warm and flushed and may even get a mild headache.
  5. Monitoring symptoms: As the test continues, the lab staff periodically asks you how you feel. Tell them if you feel pain or discomfort in your chest, arm or jaw. Also, tell them if you feel dizziness, shortness of breath, lightheadedness or other symptoms. They watch for any changes on the EKG monitor that tell them they should stop the test.
  6. End of test: After the test, your healthcare provider removes the IV from your arm. Your heart rate should return to normal within five to 10 minutes.

Can I eat and drink before a dobutamine stress test?

You can eat and drink most foods up to four hours before the test. You can continue to drink water until right before the test.

Don’t smoke on the day of the test. Nicotine can affect the results of your echocardiogram.

Avoid caffeine (including soda, energy drinks, chocolate, coffee or tea) for 24 hours before the test. Caffeine can affect test results. And don’t eat or drink decaffeinated or caffeine-free products, which still have small amounts of caffeine.

Should I take my medications before a dobutamine stress test?

Your healthcare provider may ask you to stop taking some of your heart medications on the day of your test or 24 hours before the test.

Sometimes, you can continue to take your medication, like if you need it to treat chest pain or discomfort. Bring your medications with you to the test. And never stop taking medication without first talking with your healthcare provider.

Medications you will likely need to stop taking include:

  • Beta-blockers, including atenolol (Tenormin®), carvedilol (Coreg®), metoprolol (Lopressor®, Toprol®) and propranolol (Inderal®).
  • Isosorbide dinitrate, including Dilatrate®, Isordil® and Sorbitrate®.
  • Isosorbide mononitrate, including Ismo®, Imdur® and Monoket®.
  • Nitroglycerin, including Minitran®, Nitropatches® and Nitrostat®.

Don’t take over-the-counter medications that have caffeine for 24 hours before the test, such as diet pills, NoDoz®, Excedrin® and Anacin®. Ask your healthcare provider or pharmacist if you have questions about medications that may have caffeine.

Contact your healthcare provider if you have any questions about your medications.

Should I take my diabetes medication before a dobutamine stress echocardiogram?

Ask your healthcare provider if you have diabetes. They may tell you to take less or no medication until after the test. For example:

  • If you take insulin to control blood sugar: Your healthcare provider may tell you to take half of your morning dose and to eat a light snack four hours before your test starts. Don’t take your diabetes medication and skip a meal before the test.
  • If you take medication to control your blood sugar: Your provider may tell you to take your medication after the test.
  • If you own a glucose monitor: Bring the monitor with you. Before and after the test, you will need to check your blood sugar levels. Tell someone at the lab right away if your blood sugar is low. After the test, you should eat and take your diabetes medication.

What clothing should I wear to my dobutamine stress echocardiogram?

You can wear anything you’d like. Before the test, you’ll change into a hospital gown. Don’t bring valuables (such as jewelry) with you on the day of the test. You can place your belongings in a locker during the test.

What are the side effects or risks of dobutamine?

You may get a mild headache when dobutamine enters your system. Another common side effect is a slight drop in blood pressure. You may also develop irregular or abnormally fast heart rhythms such as atrial fibrillation or ventricular tachycardia. It is important to discuss with your healthcare provider whether you may be at risk of these side effects.

If your provider used contrast dye, there’s a slight risk of an allergic reaction. Let your healthcare team know if you’ve had allergic reactions to contrast dyes in the past.

People with angina have an extremely small risk of having a heart attack during the procedure. Your healthcare team will provide emergency care if that happens.

Can I have a dobutamine stress test if I have a pacemaker or defibrillator?

If you have a pacemaker or defibrillator, your healthcare provider must check it before your dobutamine stress echo test. Call your provider to let them know.

How long is a dobutamine stress echocardiogram?

The appointment takes about one hour. The IV is in for about 15 minutes.

What can I expect after a dobutamine stress echocardiogram?

Plan to stay in the waiting room for at least 30 minutes after the procedure is over or until any symptoms you experienced (including a raised heart rate) have returned to normal.

Can I drive after a dobutamine stress test?

Dobutamine can cause a slight drop in blood pressure. So it’s best to have someone else drive you home from your appointment.

Results and Follow-Up

What do the results of a dobutamine stress echo mean?

There are three types of dobutamine stress echo test results:

  • Positive or abnormal: This result means you have reduced blood flow in your heart. This could indicate coronary artery disease, scarring on your heart muscle or poor physical fitness. It may also mean your current heart treatment isn’t working. You may need more testing if you get a positive or abnormal result. Your healthcare provider will discuss the next steps with you.
  • Negative or normal: This result means your heart responds normally to stress.
  • Inconclusive (equivocal): Your provider can't make a diagnosis from the results. You may need more testing.

How accurate is a dobutamine stress test?

Stress echocardiography can be highly accurate. In one study of 5,131 people, the test accurately predicted heart problems in more than 95% of the cases. However, there are instances of false positives or false negatives. It is important to discuss the best test for your symptoms with a cardiologist.

When should I know the results of the dobutamine stress echocardiogram?

After a cardiologist reviews your test, they enter the results into your electronic medical record. Your healthcare provider checks the results and discusses them with you. Contact your provider if you don’t hear from them within one week of your test.

A note from Cleveland Clinic

A dobutamine stress echocardiogram is a highly accurate way for healthcare providers to see how your heart reacts to stress. This test can give you answers about heart symptoms or let you know if your treatment plan is working. It’s an important part of helping your healthcare team care for your heart. You might feel a slight poke when your provider inserts the IV (to inject the dobutamine), but otherwise, the test is painless. Talk to your provider if you have any questions or concerns about a dobutamine stress echo test.

Last reviewed by a Cleveland Clinic medical professional on 09/06/2022.

References

  • American Heart Association. Echocardiogram (Echo). (https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/echocardiogram-echo) Accessed 9/6/2022.
  • National Heart, Lung, and Blood Institute. Heart Tests. (https://www.nhlbi.nih.gov/health-topics/stress-test) Accessed 9/6/2022.
  • The National Heart Foundation of New Zealand. Dobutamine stress echocardiogram. (https://www.heartfoundation.org.nz/resources/dobutamine-stress-echocardiogram) Accessed 9/6/2022.
  • Woodward W, Dockerill C, McCourt A, et al. Real-world performance and accuracy of stress echocardiography: The Evarest Observational multi-centre study. (https://academic.oup.com/ehjcimaging/article/23/5/689/6306803) European Heart Journal - Cardiovascular Imaging. 2021;23(5):689-698. Accessed 9/6/2022.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy