Dobutamine Stress Echocardiography (DSE)

What is Dobutamine Stress Echocardiography?

Echocardiography uses ultrasound waves (high-frequency sound waves) to check heart muscle and blood vessels motion.

Dobutamine stress echocardiography (DSE) is a non-exercise stress test that allows the cardiologist to see how your heart muscles work under stress. Doctors will inject dobutamine, a cardiac medication, into a vein in increasing doses to increase heart rate. Ultrasound images are then obtained to study how your heart reacts. This is then compared to the images obtained at rest to see if any part of the heart contracts abnormally.

What is the purpose of this test?

The narrowing of heart or coronary arteries may not affect the body during rest. However, the blood flow may be inadequate to meet the heart's needs muscles during stress. This relative lack of blood supply causes cardiac chest pain and may be a heart attack warning sign. DSE is a safe test for inducing cardiac chest pain. DSE is also more accurate than ECG treadmill exercise tests for detecting any narrowing in coronary arteries.

What can I expect?

DSE takes place in the Clinic Echo Laboratory. Usually, it takes about an hour. You will be lying mostly on your left side and you may have to hold your breath for short periods of time. The doctor will explain the procedure and ask you to sign a consent form beforehand.

An IV cannula will be fitted to your hand for the dobutamine infusions. You'll also have ECG leads on your chest that will track the heart rhythm. The doctor may shave off excess chest hair. Your blood pressure and ECG will be monitored.

To improve contact for the ultrasound probe, the doctor will apply gel to your chest. A cardiac technologist will then place the probe on your chest to get the best possible ultrasound images before, during and after dobutamine infusion.

It is normal to feel your heart beating faster and harder during the examination. You may also feel a little short of breath. These will resolve once the infusion stops. If needed, you'll receive another medication, atropine.

At the end of the examination, the technologist will help you clean up the gel - it's water soluble and easy to clean. The ECG leads and IV needle will be removed. You will need to rest for at least 30 minutes to 1 hour before leaving the hospital.

What should I do before the test?

Please arrive 15 minutes before your scheduled appointment time for registration and test preparation.

  1. Avoid food and drink for at least 2 hours before the test.
  2. No decaffeinated, caffeine or chocolate beverages 24 hours before the procedure.
  3. Need to wear comfortable clothes and walking shoes.
  4. Take your medicines as usual with water and on schedule
  5. Hold Beta Blockers 24 hours before the test (bring a dose with you to take after the test).
  6. Hold Theo-Dur or any Theophylline like drug 24 hours before the test (may use inhalers)
  7. Hold Persantine (Dipyridamole) 24 hours before the test.
  8. Hold off on long-acting persantine must for 3 days before the test
  9. Please check with your doctor if you need to stop any of your medications. Bring a list of all the medications you are currently taking

Patients who have prostate problems or glaucoma should not receive atropine. Please inform the technologist or doctor supervising the test if you have these conditions.

What are the potential risks and complications?

Ultrasound is safe and has no material side effects, even with repeated examinations.

Possible adverse effects of dobutamine include palpitations, chest pain, shortness of breath, nausea, vomiting, dizziness and flushing. These are transient and will disappear within minutes after the test is completed. Leakage of the drug at the infusion site may cause local pain and inflammation.

Atropine may cause blurring of vision, dry mouth, flushing, abdominal discomfort and retention of urine (1%). These symptoms may last up to a few hours after the test.

If an ultrasound contrast agent is used during the procedure, you will be monitored for any allergic or adverse drug reaction after the procedure.

Major complications are very rare. They include heart attack and severe heart rhythm abnormality, and death. If you feel chest pain or any other discomfort during the test, please inform the technologist or supervising doctor.

When will I know the result?

The supervising doctor will need to review recorded computed images and ECG recordings of the DSE procedure. Your doctor will inform you of the results, usually at your next outpatient clinic visit. A formal report should be available in 24-48 hours. You may be contacted earlier if there is a severe abnormality or an urgent management decision is required pending the results.

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