This is a specialised investigation which can provide information about the blood flow in the coronary arteries and is useful in the investigation of ischaemic heart disease.

This test is useful if you cannot exercise on a treadmill. It is also an option for those patients who have developed significant symptoms or ECG changes on an exercise test and would like a further test before considering an invasive cardiac catheter.

In a normal heart when the heart rate increases, heart muscle moves in a coordinated manner. If however there are narrowings in the coronary arteries (ischaemic heart disease) the muscle moves abnormally. The movement of the heart muscle can be observed using a heart scan (echocardiogram).

One way of increasing heart rate is by infusing a medication called dobutamine into a vein, which mimics the effects of exercise on the heart.

IN PREPARATION

You will be advised to either continue your usual medication or to stop certain medication for 1-2 full days before the test.

You should eat no more than a light meal beforehand, but avoid tea and coffee (unless decaffeinated) and also avoid alcohol and smoking before attending for the test. Insulin treated diabetics may need to take additional carbohydrate or reduce their insulin to prevent hypoglycaemia after the test.

You should wear loose comfortable clothing (ladies should not wear 'long line' or 'all in one' under garments). You should also have with you any medication that you are taking.

You should inform the staff performing the test if there has been any change in your symptoms since you were last seen.

HOW IS IT DONE?

A dobutamine stress echocardiogram may be performed on an outpatient basis or as part of your stay in a hospital.

As opposed to walking on a treadmill you will lie down on a couch and frequent scans of your heart are taken to look at the movement of the heart muscle.

You will be connected to an monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Your heart rate and blood pressure will be monitored during the procedure.

An intravenous (IV) line will be inserted in your hand or arm for injection of medication.

 

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 or until the maximum dose of dobutamine has been reached. If your heart rate increases slowly small doses of another medication, atropine, may be added.

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 obtained. You may also have a contrast agent injected in to your vein at each stage of the test to improve the image quality.

Once all the images have been taken, the ECG electrode pads and IV line will be removed. You may then put on your clothes.

The results are usually available immediately and you can usually go home within half an hour after the procedure has finished.

ARE THERE ANY RISKS?

Since the test involves stressing the heart, there is a very small risk of causing a change in rhythm of the heart or exceedingly rarely a heart attack. However, even in patients who have recently experienced a heart attack, the chance of a serious problem occurring during a test is only one in 700. You will be carefully observed during the test and treatment will be available should a complication occur.

WHY IS A DOBUTAMINE STRESS ECHOCARDIOGRAM USEFUL?

A dobutamine stress echocardiogram can give detailed information about the heart during exercise. This is commonly useful for evaluating the cause of chest pain. It can provide information about the blood flow in the coronary arteries which cannot be detected on the ordinary resting ECG. The test gives better results than a standard exercise test. This is an excellent, relatively inexpensive way of non-invasively investigating for the presence of coronary artery disease.

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