Heart needs more blood supply under stress like exercise. A stress echocardiogram is a test done to assess how well the heart works under stress and whether blood supply is adequate or not. The “stress” can be triggered by either exercise on a treadmill or a medicine called dobutamine.

A dobutamine stress echocardiogram (DSE) may be used if you are unable to exercise. Dobutamine is put in a vein and causes the heart to beat faster. It mimics the effects of exercise on the heart. If a blood vessel to a particular part of heart is partially blocked, blood supply to that part may be inadequate during stress. This result into abnormal motion of that part of the heart which can be picked up with help of echocardiography.

Why might I need a dobutamine stress echocardiogram?

Possible reasons for getting a dobutamine stress echocardiogram (DSE) may include:

• To assess adequacy of blood supply to heart
• To further assess the degree of known heart valve disease
• To determine limits for safe exercise before you start a cardiac rehabilitation program or are recovering from a cardiac event, such as a heart attack (myocardial infarction, or MI) or heart surgery
• To evaluate the cardiac status before heart surgery

There may be other reasons for your doctor to recommend a DSE.

What are the risks of a dobutamine stress echocardiogram?

Possible risks associated with a dobutamine stress echocardiogram (DSE) include:

• Chest pain
• Severely high blood pressure
• Irregular heartbeats
• Dizziness
• Nausea
• Extreme tiredness
• Heart attack (rare)

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the test.

Certain factors or conditions may interfere with a DSE such as:

• Smoking or using any other form of tobacco within 3 hours of the test
• Ingesting caffeine within 3 hours of the test
• Taking beta-blocking medicines – these may make it hard to increase the heart rate to an appropriate level.

How do I get ready for a dobutamine stress echocardiogram?

• Your doctor will explain the test to you and let you ask questions.
• You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if anything is not clear.
• Tell the doctor if you are allergic to or sensitive to any medicines or latex.
• Fasting (not eating) may be required before the test. Your doctor will give you instructions on how long you should withhold food and liquids. Tobacco use and caffeinated beverages, such as coffee, tea, and soda, may be restricted several hours before testing.
• Tell your doctor of all medicines (prescription and over-the-counter), vitamins, herbs, and supplements that you are taking.
• You may be instructed to hold certain medicines before the test, such as beta-blockers. Your doctor will give you specific instructions
• Tell your doctor if you are pregnant or think you could be.
• Tell your doctor if you have a pacemaker.
• Based on your medical condition, your doctor may request other specific preparation.

What happens during a dobutamine stress echocardiogram?

A dobutamine stress echocardiogram (DSE) may be done on an outpatient basis or as part of your hospital stay. Steps may vary depending on your condition and your doctor’s practices.

Generally, a DSE follows this process:

1. You will be asked to remove any jewelry or other objects that may interfere with the test. You may wear your glasses, dentures, or hearing aids if you use any of these.
2. You will be asked to remove clothing from the waist up and will be given a gown to wear.
3. You will be asked to empty your bladder before the test.
4. An intravenous (IV) line will be started in your hand or arm before the test. It’s needed for injection of the dobutamine and to give you IV fluids, if needed.
5. You will lie on your left side on a table or bed, but may be asked to change position during the test.
6. You will be connected to an electrocardiogram (ECG) monitor that records the electrical activity of your heart and monitors your heart during the test using small electrodes that stick to your skin. Your vital signs (heart rate, blood pressure, breathing rate, and oxygen level) will be monitored during the test. The ECG tracing that records the electrical activity of your heart will be compared to the images displayed on the echocardiogram monitor.
7. The room will be darkened so that the images on the echo monitor can be seen by the technologist.
8. The doctor will place warmed gel on your chest and then place the transducer on the gel. You will feel a slight pressure as the doctor positions the transducer to get the best image of your heart.
9. The dobutamine infusion will begin at a rate determined by your weight. The rate of the infusion will be increased every few minutes until you have reached your target heart rate (determined by the doctor based on your age and physical condition), or until the maximum dose of dobutamine has been reached.
10. After the dobutamine is started and after each increase in the dobutamine, your blood pressure will be checked, an ECG tracing will be done, and echocardiogram images will be recorded.
11. The technologist will move the transducer around on your chest so that all areas and structures of your heart can be seen.
12. Once you have reached your target heart rate or the maximum amount of the dobutamine, the medicine will be stopped. Your heart rate, blood pressure, and ECG will continue to be monitored for 10 to 15 minutes until they have returned to the baseline state. Final echocardiogram pictures will be taken.
13. Tell the technologist if you feel any chest pain, trouble breathing, sweating, or heart palpitations at any time during the test.
14. Once all the images have been taken, the gel from your chest and the ECG pads and IV line are removed. You may then put on your clothes.

What happens after a dobutamine stress echocardiogram?

You may go back your usual diet and activities unless your doctor tells you differently.

Generally, there is no special type of care following a dobutamine stress echocardiogram. However, your doctor may give you other instructions after the test, depending on your particular situation

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