1. Dobutamine stress echo
MAHMOUD SOLIMAN,MD
2012

2. ???Why stress
????Why echo •
???Why dobutamine •

3. ????????Why stress
Myocardial ischaemia •
results from supply
demand mismatch leading
to cascade of events

4. .Cont
Metabolic changes •
Diastolic dysfunction •
Wall motion abnormalities •
ECG changes •
Chest pain •

5. Chest pain is the tip of
iceberg
Advanced degrees of •
coronary obstruction may
exist without
manifestations of
ischaemia at rest

6. ??????Why echo
Many patients can not perform •
physical stress

7. Many patients have abnormal resting •
ECG
LT BBB •
IVCD

8. ????Why Dobutamine
Dobutamine is a synthetic •
catecholamine with direct B1
receptor agonist effect
Also mild B2 & Alpha 1 agonist •
effect

9. 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

11. Many studies showed that •
dobutamine is more effective
than dypyridamole in
precipitating myocadial
dysfunction & well suited for
.imaging modalties

12. Test procedure

14. General considerations
Space •
Time •
Personnel •
Equipment •

15. 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 •

16. 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withdrawn 24hs before the test

17. 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 •

20. •
DOBUTAMINE ECHOCARDIOGRAM _ ECHO

21. Segmental wall motion
abnormalities

22. segments model 16
NORMAL<<<<<<<<<<<<<<<<<<<<1 •
HYPOKINE<<<<<<<<<<<<<<<<<<<<2 •
TIC
AKINETIC<<<<<<<<<<<<<<<<<<<<3 •
DYSKINET<<<<<<<<<<<<<<<<<<<<4 •
IC
ANEURYS<<<<<<<<<<<<<<<<<<<<5 •
MAL

24. Clinical implications of
DSE
Diagnosis of CAD-1 •
Sensitivity >>>>> 80% •
Specificity >>>>> 80% •

26. Assessment of post infarct-2 •
patients
Assessment of viability •
Assessment of inducible ischaemia •

27. Perioperative assessment of pts-3 •
undergoing major vascular syurgery

28. Assessment of ps with valvular - 4 •
:diseases
a- aortic stenosis with impaired LV •
FUNCTION
B-mitral stenosis •
C-Asymptomatic mitral &aortic •
regurge

31. Assessment of pts with dilated-5 •
myopathy
Idiopathic •
ischaemic •

32. •
Complications

36. International stress echo
complications registry
From 1998-2004 •
case 35103 •
serious side 63 •
(effects(death,infarction,VF
EVENT RATE 1>>>>>>>557 CASES •

41. MERCI
THANK YOU •