Dobutamine Stress Echocardiogram

 

What is it?


An echocardiogram or ‘echo’ is a scan that uses ultrasound (sound waves) to produce pictures of the heart. The scan is painless, devoid of any side effects and does not use radioactivity. The technology is identical to that used in order to check the progress of a pregnancy.
Stress echo involves giving you a drip with a drug called Dobutamine, that will increase your heart rate and make the heart work harder, while we take echo pictures of the heart.  


Aim of the test


A stress echo shows how the heart performs when it is made to work harder. It can therefore identify problems with the blood supply to the heart muscle: Areas supplied by a narrowed artery will become weaker, rather than work more vigorously as the heart rate accelerates. A stress echo can also be requested in certain cases of narrowing of the main outlet valve of the heart, the aortic valve.


What does it involve?


You will be taken into a darkened room within the Outpatient Department of the hospital. Three people will usually be present when you have the test – a doctor, a Cardiac Clinical Physiologist and an assistant.


You will be asked to undress to the waist and offered a gown to wear that should be left open to the front. You will be asked to lie on a couch on your left side.


Stickers will be attached to your chest and connected to the machine. These will be used to monitor your heart rate. Your blood pressure will also be checked regularly throughout the test. A drip will be placed in a vein in your arm for the doctor to inject a special dye called ‘contrast’ and the Dobutamine. The contrast improves the quality of the images whilst Dobutamine increases the heart rate steadily to give the heart a work-out whilst lying on the couch.


Dobutamine is a very safe drug. It is remarkably short-acting, as it disappears from the blood stream within a few minutes of stopping the infusion. Moreover, at the end of the test we will give you a small dose of the ‘antidote’ to Dobutamine, a short-acting beta-blocker drug called Metoprolol.


Dobutamine is well tolerated. Most patients will be aware of the heart beating faster and more forcefully. Often patients report a ‘tingling’ sensation on the top of the head or around the face.

 

Much rarer side effects include nausea, vomiting, anxiety, tremor, high or low blood pressure, chest tightness or shortness of breath. Due to the very short action of Dobutamine all side effects are reversible and brief. The risk of sustaining a major complication such as a heart attack or a life-threatening heart rhythm problem is similar to that of a treadmill test and very low, at about 1 in 10,000. The risk of allergy to the ‘dye’ (contrast) that we sometimes have to use to see the inside of the heart better is similarly low at 1 in several thousands.


In order for the test to be accurate we need to reach a certain ‘target’ heart rate. Sometimes the Dobutamine on its own does not increase the heart rate enough for the test to be conclusive. In this case we may need to use a second drug called Atropine, on top of the Dobutamine. We cannot use Atropine of you have severe prostate trouble which make passing water very difficult (in men) or severe glaucoma (severely increased pressure inside the eye) so we will ask you about these conditions. Atropine may give you a dry mouth and rarely slightly blurred vision; both symptoms will resolve by the time you leave the hospital.


Pictures of your heart will be recorded on the ultrasound scanner at different stages of increased heart rate. The heart rate will increase gradually, gently at first, and then progressively faster.
You will continue to have your heart rate and blood pressure monitored until a few minutes after the test.


Overall the stress echo will take around 40 to 60 minutes to complete. After the test we will ask you to stay in the waiting area for another 30 minutes before taking the small plastic tube (Venflon) out of the vein and allowing you to go home.


Are there any special precautions that I need to take before the test?


You must not take beta-blocker tablets and Calcium-channel blockers for 2 days before the scan. Beta-blocker tablets include Atenolol, Bisoprolol and Carvedilol, although there are others. Calcium-channel blockers are called Diltiazem and Verapamil. These tablets prevent the heart from working hard. If you do continue with beta-blocker or calcium-channel blocker drugs, the stress echo may need to be postponed. If you have any doubts contact your GP or pharmacist. You should continue other medications as usual.


After the stress echo


You will be able to return home after spending 30 minutes on our premises once the scan has been completed. You may undertake your day-to-day activities as usual.


Results


You will be given at least a preliminary result before you leave the hospital. A detailed letter to the doctor who has referred you for this test will be sent within a few days.


Contact information

 

Dr Ionescu’s secretary – Mrs Eileen Powell – 01792-70-3195, or
Sancta Maria Hospital, Ffynone Rd SA1 6DF, 01792-479040.

 

Research


Research is undertaken to add to the existing scientific knowledge on a particular subject. There are a number of staff who conduct Research studies. It is possible that during the course of your treatment you may be asked to take part in a research study, however, you do have the right to refuse, and this will not affect the care that you receive.

 

Admin


If you are insured please bring the number of your policy and the authorisation code for the procedure. The cost of the procedure is £500, and you will be invoiced if you are self-funded.


Data Protection


The Hospital will do its best to ensure that your information remains secure and confidential at all times. The Data Protection Act 1998 explains how personal information should be processed and this applies to all information whether held on paper or electronically on computer systems.
If you have a concern or there is a problem, the best way to get it resolved is usually to tell someone there and then. On a ward, talk to the sister or charge nurse on duty. In a clinic, talk to the receptionist or one of the nursing staff. If you want to talk to a senior manager or to someone who has not been directly involved in your care and treatment, we can usually arrange this during office hours.


If you wish to make a formal complaint you can write to the Hospital Director, Sancta Maria Hospital, Ffyone Rd, Uplands, Swansea SA6 1DF.