A dobutamine stress echocardiogram is a diagnostic procedure that may be
used when a physician wants to assess the heart muscle under stress. If
exercise on a treadmill is not an option (too much stress on the heart)
due to a person’s medical condition, a physician may use an intravenous
medication called dobutamine. Dobutamine causes the heart to beat faster
and will mimic the effects of exercise on the heart.
An echocardiogram is a noninvasive (the skin is not pierced) procedure
used to assess the heart's function and structures. During the
procedure, a transducer (like a microphone) sends out ultrasonic sound
waves at a frequency too high to be heard. When the transducer is placed
on the chest at certain locations and angles, the ultrasonic sound waves
move through the skin and other body tissues to the heart tissues, where
the waves echo off of the heart structures. The transducer picks up the
reflected waves and sends them to a computer. The computer interprets
the echoes into an image of the heart walls and valves.
A dobutamine stress echocardiogram may utilize one or more of four
special types of echocardiography, as listed below:
This, the simplest type of echocardiography, produces an image
that is similar to a tracing rather than an actual picture of
heart structures. M-mode echo is useful for measuring heart
structures, such as the heart's pumping chambers, the size of
the heart itself, and the thickness of the heart walls.
This Doppler technique is used to measure and assess the flow of
blood through the heart's chambers and valves. The amount of
blood pumped out with each beat is an indication of the heart's
functioning. Also, Doppler can detect abnormal blood flow within
the heart, which can indicate a problem with one or more of the
heart's four valves or with the heart's walls.
Color Doppler is an enhanced form of Doppler echocardiography.
With color Doppler, different colors are used to designate the
direction of blood flow. This simplifies the interpretation of
the Doppler technique.
2D (2-dimensional) echocardiography
This technique is used to visualize the actual structures and
motion of the heart structures. A 2D echo view appears
cone-shaped on the monitor, and the real-time motion of the
heart's structures can be observed. This enables the physician
to see the various heart structures at work and evaluate them.
Other related procedures that may be used to assess the heart include
resting or exercise electrocardiogram (ECG or EKG), Holter monitor,
signal-averaged ECG, cardiac catheterization, chest x-ray, computed
tomography (CT scan) of the chest, electrophysiological studies,
magnetic resonance imaging (MRI) of the heart, myocardial perfusion
scans, radionuclide angiography, and ultrafast CT scan. Please see these
procedures for additional information.
Reasons for the Procedure
Possible indications for a dobutamine stress echocardiogram may include,
but are not limited to, the following:
to assess the heart's function and structures
to determine limits for safe exercise in patients who are
entering a cardiac rehabilitation program and/or those who are
recovering from a cardiac event, such as a heart attack
(myocardial infarction, or MI) or heart surgery
to evaluate blood pressure during stress testing
to assess stress or exercise tolerance in patients with known or
suspected coronary artery disease
to evaluate the cardiac status of a patient about to undergo
There may be other reasons for your physician to recommend a dobutamine
Risks of the Procedure
Possible risks associated with a dobutamine stress echocardiogram
include, but are not limited to, the following:
severely high blood pressure
nausea and extreme fatigue
heart attack (rare)
Patients who are allergic to or sensitive to medications or latex should
notify their physician.
If you are pregnant or suspect that you may be pregnant, you should
notify your physician due to risk of injury to the fetus from a
dobutamine stress echo. If you are lactating, or breastfeeding, you
should notify your physician.
There may be other risks depending upon your specific medical condition.
Be sure to discuss any concerns with your physician prior to the
Certain factors or conditions may interfere with a dobutamine stress
echocardiogram. These factors include, but are not limited to, the
smoking or ingesting caffeine within three hours of the
beta-blocking medications may make it difficult to increase the
Before the Procedure
Your physician will explain the procedure to you and offer you
the opportunity to ask any questions that you might have about
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 something is not clear.
Notify the physician if you are allergic to or sensitive to
medications or latex.
Fasting may be required before the procedure. Your physician
will give you instructions as to how long you should withhold
food and/or liquids. In some cases, cigarettes and caffeinated
beverages, such as coffee, tea, and cola may be restricted
several hours before testing.
If you are pregnant or suspect that you may be pregnant, you
should notify your physician.
Notify your physician of all medications (prescription and
over-the-counter) and herbal supplements that you are taking.
Notify your physician if you have a pacemaker.
Based upon your medical condition, your physician may request
other specific preparation.
During the Procedure
A dobutamine stress echocardiogram may be performed on an outpatient
basis or as part of your stay in a hospital. Procedures may vary
depending on your condition and your physician's practices.
Generally, a dobutamine stress echocardiogram follows this process:
You will be asked to remove any jewelry or other objects that
may interfere with the procedure. You may wear your glasses,
dentures, or hearing aids if you use any of these.
You will be asked to remove clothing from the waist up and will
be given a gown to wear.
You will be asked to empty your bladder prior to the procedure.
An intravenous (IV) line will be started in your hand or arm
prior to the procedure for injection of medication and to
administer IV fluids, if needed.
You will lie on your left side on a table or bed, but may be
asked to change position during the procedure.
You will be connected to an ECG monitor that records the
electrical activity of the heart and monitors the heart during
the procedure using small, adhesive electrodes. Your vital signs
(heart rate, blood pressure, breathing rate, and oxygenation
level) will be monitored during the procedure. The ECG tracing
that will record the electrical activity of the heart will be
compared to the images displayed on the echocardiogram monitor.
The room will be darkened so that the images on the echo monitor
can be viewed by the technologist.
The technologist will place warmed gel on your chest and then
place the transducer probe on the gel. You will feel a slight
pressure as the technologist positions the transducer to get the
desired image of your heart.
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 physician based on your age and physical
condition), or until the maximum dose of dobutamine has been
After the dobutamine is started and after each increase in the
dobutamine rate, your blood pressure will be checked, an ECG
tracing will be performed, and echocardiogram images will be
The technologist will move the transducer probe around on your
chest so that all areas and structures of your heart can be
observed. The different echocardiogram techniques described
above (M-mode, 2D, Doppler, and color Doppler) may be used. You
will not be aware of the different techniques except that during
the Doppler or color Doppler, you may hear a "whoosh-whoosh"
sound, which is the sound of the blood moving through the heart.
Once you have reached your target heart rate or the maximum
amount of the dobutamine, the medication will be stopped. Your
heart rate, blood pressure, ECG, and echo will continue to be
monitored for 10 to 15 minutes until they have returned to the
You should notify the technologist if you feel any chest pain,
breathing difficulties, sweating, or heart palpitations.
Once all the images have been taken, the technologist will wipe
the gel from your chest, remove the ECG electrode pads, and
remove the IV line. You may then put on your clothes.
After the Procedure
You may resume your usual diet and activities unless your physician
advises you differently.
Generally, there is no special type of care following a dobutamine
stress echocardiogram. However, your physician may give you additional
or alternate instructions after the procedure, depending on your
The content provided here is for informational purposes only, and was
not designed to diagnose or treat a health problem or disease, or
replace the professional medical advice you receive from your physician.
Please consult your physician with any questions or concerns you may
have regarding your condition.
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procedure and related health conditions. We hope you find these sites
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