This document discusses dobutamine stress echo, including: 1. Dobutamine stress echo is used to detect myocardial ischemia by inducing wall motion abnormalities, ECG changes, and symptoms through increasing myocardial oxygen demand. 2. Echo is used to visualize any wall motion abnormalities induced during stress. Dobutamine is preferable to other stressors as it more effectively precipitates myocardial dysfunction and is well-suited for imaging modalities. 3. The test involves gradually increasing doses of dobutamine infusion while monitoring for changes on ECG and echo. It has clinical implications for diagnosing CAD, assessing viability and inducible ischemia, and perioperative risk assessment. Serious complications are very rare.

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withdrawn 24hs before the test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 •