Dobutamine stress echocardiography

If a patient is unable to perform an exercise test because of mobility problems, a pharmacologic stress test should be utilized (e.g., Dobutamine stress echocardiography).A man who cannot achieve 3-4 METs should be further evaluated by angiography if appropriate (3). 

Friart A, Hermans L, De Valeriola Y. Unusual side-effect of a dobutamine stress echocardiography. Am J Noninvasive Cardiol 1993 7 63M. 

The value and safety of dobutamine stress echocardiography have been studied in 135 patients aged 70 years or older (mean age 74 years 58% men) soon after... 

Myocardial ischemia has also been reported in susceptible patients. A Japanese group carried out dobutamine stress echocardiography in 51 patients with a presumptive diagnosis of variant angina (17). All had coronary vasospasm in response to intracoronary acetylcholine and seven also had chest pain and reversible ST segment elevation. One must incidentally wonder whether this procedure was entirely advisable. 

In one study 38% of patients undergoing dobutamine stress echocardiography developed hypotension. Increases in blood pressure are more in hne with what one would expect. Although dobutamine does not as a rule cause a marked increase in systolic blood pressure in normotensive patients, hjrpertensive patients can develop marked systolic hypertension during an infusion of the drug. When stress echocardiography with dobutamine is performed in subjects who prove to be entirely healthy, an audible Still s-like vibratory systolic ejection murmur is nevertheless produced. 

Lattanzi F, Picano E, Adamo E, Varga A. Dobutamine stress echocardiography safety in diagnosing coronary artery disease. Drug Saf 2000 22(4) 251-62. 

Previtali M, Scelsi L, Sebastian R, Lanzarini L, Raisaro A, Klersy C. Feasibility, safety, and prognostic value of dobutamine stress echocardiography in patients > or = 70 years of age early after acute myocardial infarction. Am J Cardiol 2002 90(7) 792-5. 

Poldermans D, Rambaldi R, Bax JJ, Cornel JH, Thomson IR, Valkema R, Boersma E, Fioretti PM, Breburda CS, Roelandt JR. Safety and utility of atropine addition during dobutamine stress echocardiography for the assessment of viable myocardium in patients with severe left ventricular dysfunction. Eur Heart J 1998 19(11) 1712-18. 

Burger AJ, Notarianni MP, Aronson D. Safety and efficacy of an accelerated dobutamine stress echocardiography protocol in the evaluation of coronary artery disease. Am J Cardiol 2000 86(8) 825-9. 

Kawano H, Fuji H, Motoyama T, Kugiyama K, Ogawa H, Yasue H. Myocardial ischemia due to coronary artery spasm during dobutamine stress echocardiography. Am J Cardiol 2000 85(1) 26-30. 

Beckmann S, Bocksch W, Muller C, Schartl M. Does dobutamine stress echocardiography induce damage during via-bihty diagnosis of patients with chronic regional dysfunction after myocardial infarction J Am Soc Echocardiogr 1998 ll(2) 181-7. 

Geleijnse ML, Fioretti PM, Roelandt JRTC. Methodology, feasibihty, safety and diagnostic accuracy of dobutamine stress echocardiography. J Am Coll Cardiol 1997 30 595-606. 

Ahmad M, Xie T, McCulloch M, Abreo G, Runge M (2001) Realtime three-dimensional dobutamine stress echocardiography in assessment stress echocardiography in assessment of ischemia comparison with two-dimensional dobutamine stress echocardiography. J Am Coll Cardiol 37 1303-1309... 

Risk Factors of LEAD Co-Existing With Coronary Artery Disease Other Than Over 40 Years of Age What Do Patients With Lower Extremity Arterial Disease Assessed With a Low Ankle-Brachial Index Die From Dobutamine Stress Echocardiography Management... 

Reversible severe left ventricular systolic dysfunction with apical ballooning has abo been reported during dobutamine stress echocardiography [45, 46, 47, 48, 49, 50, 51, 52, 53, 54 ] and abo in one case after recovery from stress echocardiography [55 ]. In one case it occurred in a patient with previous orthotopic heart transplantation [56 ]. In another case it occurred in a patient who had had a subarachnoid haemorrhage [57 ], in which sympathetic nervous system activity b increased and in which acute myocardial infarction can abo occur. 

Piloerection, which occurred in 92 (42%) of 218 consecutive patients who underwent dobutamine stress echocardiography, correlated with the age of the patients and was present in 73% of patients aged 50 years or younger [93 ]. Piloerection is a frequent adverse effect of dobutamine infusion, particularly in patients aged 50 years or less, and it occurs most often at a dose of 10 micrograms/kg/minute. It usually precedes the increase in heart rate caused by dobutamine, and is therefore an early and clear indication that the intravenous infusion is working properly. 

Vasconcelos Filho FJ, Gomes CA, Queiroz OA, Barreto JE. Dobutamine stress echocardiography-induced broken heart syndrome (takotsubo syndrome). Arq Bras Cardiol 2009 93(1) e5-7. 

Shah BN, Simpson lA, Rakhit DJ. Takotsubo (apical ballooning) syndrome in the recovery period following dobutamine stress echocardiography a first report. Eur J Echocardiogr 2011 12(1) E5. 

Rekik S, Aboukhoudir F, Andrieu S, Pansieri M, Hirsch JL. Impressive ST-seg-ment elevation during dobutamine stress echocardiography in a patient with normal coronary arteries dobutamine-induced vasospasm J Electrocardiol 2009 42(5) 414-9. 

Hecker T, De Pasquale CG, Perry R, Brown L, Katsounis H, Joseph MX. Side-effects of high-dose dobutamine are not prevented by normal saline infusion in dobutamine stress echocardiography. Echocardiography 2008 25(7) 712-6. 

Dobutamine stress echocardiography is a generally well-tolerated study to evaluate patients with suspected coronary artery disease. Rare but life-threatening complications of this study have been well described. Severe hypertensive responses are a known but uncommon adverse reaction to dobutamine infusion. A case of intracranial haemorrhage in the setting of severe hypertension as a complication of dobutamine stress echocardiography was reported. The patient was on systemic anticoagulation with warfarin for a prosthetic mitral valve and had... 

Shah SP, Chaudhry GM. Intracranial hemorrhage as a complication of dobutamine stress echocardiography case report and review of the literature. Echocardiography 2012 29(5) E119-21. 

Okada DR, Okada RD, Bonow RO. Beta adrenergic receptor blockade causing severe left ventricular systolic dysfunction during dobutamine stress echocardiography in a patient with no structural heart disease. Echocardiography February 2012 29(2) E39-42. 

---