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Dobutamine stress echo
  MAHMOUD SOLIMAN,MD
         2012
???Why stress

????Why echo •


???Why dobutamine •
????????Why stress


Myocardial ischaemia •
results from supply
demand mismatch leading
to cascade of events
.Cont
           Metabolic changes        •

          Diastolic dysfunction         •

        Wall motion abnormalities           •

              ECG changes       •

               Chest pain   •
Chest pain is the tip of
         iceberg
Advanced degrees of •
coronary obstruction may
exist without
manifestations of
ischaemia at rest
??????Why echo
Many patients can not perform •
physical stress
Many patients have abnormal resting •
ECG
LT BBB •


IVCD
????Why Dobutamine
Dobutamine is a synthetic •
catecholamine with direct B1
receptor agonist effect
Also mild B2 & Alpha 1 agonist •
effect
There are two types of stressors •
A-Those induce or inhance •
misdistributions of coronary blood
flow eg.Dypridamole& adenosine
B-Those increase myocardial oxygen •
demand eg. Dobutamine
Many studies showed that •
dobutamine is more effective
than dypyridamole in
precipitating myocadial
dysfunction & well suited for
.imaging modalties
Test procedure
General considerations
Space •


Time •


Personnel •


Equipment •
Space: should be large enough to      •
        accommodate equipment &
       free movement of personnel
.       especially in emergencies
.Time :about 90 mins •
  Personnel :cardiologist & nurse •
    Equipment: machine & crush trolly •
Patient preparation
The test should be discussed with •
the patient & written informed
.consent should be obtained

B.BLOCKERS,Ca Chanell •
blokers,Nitrates should be
.withdrawn 24hs before the test
Dobutamine stress protocols
Baseline recording of BP, 12 lead ECG •
& Standard views(Parasternal
(.long&short,apical four& two
Dobutamine infused at 3-5 mins •
stages at increasing
doses:5,10,20,30&40ug/kg/min
Atropine 0.25-1 mg may also used •
•
DOBUTAMINE ECHOCARDIOGRAM _ ECHO
Segmental wall motion
   abnormalities
segments model 16
NORMAL<<<<<<<<<<<<<<<<<<<<1 •
HYPOKINE<<<<<<<<<<<<<<<<<<<<2 •
TIC
AKINETIC<<<<<<<<<<<<<<<<<<<<3 •
DYSKINET<<<<<<<<<<<<<<<<<<<<4 •
IC
ANEURYS<<<<<<<<<<<<<<<<<<<<5 •
MAL
Clinical implications of
            DSE
Diagnosis of CAD-1 •


Sensitivity >>>>>   80% •


Specificity >>>>>   80% •
Assessment of post infarct-2 •
patients


Assessment of viability •


Assessment of inducible ischaemia •
Perioperative assessment of pts-3 •
 undergoing major vascular syurgery
Assessment of ps with valvular - 4 •
:diseases
a- aortic stenosis with impaired LV •
FUNCTION
B-mitral stenosis •
C-Asymptomatic mitral &aortic •
regurge
Assessment of pts with dilated-5 •
myopathy


Idiopathic •
ischaemic •
•


Complications
International stress echo
 complications registry
From 1998-2004 •
case 35103 •
serious side 63 •
(effects(death,infarction,VF


EVENT RATE     1>>>>>>>557 CASES •
MERCI

  THANK YOU •

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