Dobutamine stress testing

In 47 consecutive patients (mean age 64 years, 46 men) with three or more cardiovascular risk factors, intravenous dobutamine was given at a rate of 40micro-grams/kg/minute until the target heart rate was achieved, which took a mean of 11.6 minutes (4). Subjective sensations occurred in 49% of the patients (palpitation 21%, chest pain 6%, nausea 6%, headache 6%, dizziness 13%), while half the patients had abnormal cardiac rhythms (ventricular extra beats 38%, supraventricular tachycardia 10%, and non-sustained ventricular tachycardia 2%). The authors concluded that the safety and tolerability of this procedure is comparable to that of standard dobutamine stress testing, although its specificity and selectivity are still uncertain. 

Lu D, Greenberg MD, Little R, Malik Q, Fernicola DJ, Weissman NJ. Accelerated dobutamine stress testing safety and feasibility in patients with known or suspected coronary artery disease. Clin Cardiol 2001 24(2) 141-5. 

Varga A, Picano E, Lakatos F. Fatal ventricular fibrillation during a low-dose dobutamine stress test. Am J Med 2000 108(4) 352-3. 

Blocker and calcium channel blocker therapy may interfere with the heart rate response to dobutamine stress tests and is... 

Digital subtraction angiography Dipyridamole-thallium scan Dobutamine stress test Doppler studies Echocardiography Electrocardiography Electrophysiologic study Fibrinogen... 

Other cases have been reported, for example, after the use of atropine as part of a dobutamine stress test [99" ] and after the use of transdermal scopolamine [100 ]. 

Skolnick AH, Michelin K, Nayar A, Fisher D, Kronzon I. Transient apical ballooning syndrome precipitated by dobutamine stress testing. Ann Intern Med... 

Sonmez O, Duman C, Duzenli MA, Tokac M. Special attention for elderly women atypical left ventricular apical ballooning syndrome induced by dobutamine stress test a case report. J Am Geriatr Soc 2009 57(9) 1735-6. 

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). 

A report from the Mayo Clinic has described 27 elderly patients (mean age 71 years) with aortic stenosis in whom dobutamine stress hemodynamic testing was used to assess the severity of the stenosis (12). There were no severe adverse effects, but relatively minor problems occurred in 16 patients, including chest pain and ventricular extra beats (n = 9 each) and atrial dysrhythmias (n — 4). The authors concluded that the procedure appears to be safe in these high-risk patients, although its diagnostic value may be limited. 

Beleshn BD, Ostojic M, Stepanovic J, et al. Stress echocardiography in the detection of myocardial ischemia Head to toe comparison of exercise, dobutamine, and dipyridamole test. Circulation 1994 90 1168—1176. 

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