Dobutamine Stress Echocardiography

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Evaluation of myocardial ischemia
  • Evaluation for transplant vasculopathy
CONTRAINDICATIONS
  1. Ongoing acute coronary syndrome or acute myocardial infarction within 48 hours
  2. High risk unstable angina
  3. Uncontrolled arrhythmia
  4. Symptomatic congestive heart failure
  5. Severe arterial hypertension (SBP > 200 mm Hg)
EQUIPMENT
  • Ultrasound scanning bed, pillow, backrest, bed linens
  • Ultrasound system
  • IV infusion pump
  • Equipment for placement of IV catheter
  • Dobutamine infusion, atropine (IV push), beta-blocker (IV push)
  • ECG machine and blood pressure monitor
  • Oxygen delivery system
  • Resuscitation equipment (crash cart, defibrillator with emergency pharmaceuticals)
  • If transpulmonary contrast use is anticipated, contrast agent

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • The patient should be observed until vital signs have returned to baseline, patient is asymptomatic, and ECG changes, if any, have resolved.
  • Any questions from patient should be answered, and if necessary, follow-up plans should be arranged.
  • Once the patient’s condition is stable, the IV should be discontinued.
  • The physician reviews echo images, ECG tracings, and patient data. The stress echo report is written and finalized.
COMPLICATIONS
  • There are no absolute contraindications for stress echo.
  • Microbubble transpulmonary contrast is contraindicated in patients with severe pulmonary hypertension and known hypersensitivity to echo contrast agents.
  • Patients may experience angina, dyspnea, or palpitations during the study.
RESULT ANALYSIS

Absolute indications to terminate the test include progressive decline in SBP of ≥ 10 mm Hg despite increased workload when accompanied by other evidence of ischemia, onset of severe angina, signs of poor perfusion (cyanosis, pallor), malignant arrhythmia such as ventricular tachycardia, ST elevation (≥1 mm) in contiguous leads, and technical difficulties in monitoring ECG or blood pressure.


Relative indications to terminate the test include ST or QRS changes, such as excessive ST-segment depression (>2 mm of horizontal or down-sloping ST-segment depression) or marked axis shift; significant arrhythmias such as sustained ventricular tachycardia, multiple multifocal premature ventricular contractions, supraventricular ventricular tachycardia, heart block, or bradyarrhythmias; excessive patient symptoms such as significant shortness of breath, wheezing, development of bundle branch block or conduction delay that cannot be distinguished from ventricular tachycardia; and a hypertensive response to dobutamine (SBP > 250 mm Hg or diastolic blood pressure [DBP] > 115 mm Hg). A number of factors affect pharmacologic stress echo interpretation and accuracy.

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