Dobutamine Stress Echocardiogram (DSE)
You have been asked to attend to have a Dobutamine Stress Echocardiogram (DSE). This leaflet is designed to help you understand the procedure.
What is a Dobutamine Stress Echocardiogram (DSE)?
A dobutamine stress echocardiogram (DSE) is an ultrasound scan of the heart taken whilst exercising the heart with a drug called dobutamine.
Dobutamine mimics exercise and allows us to see how the heart responds to performing exercise (stress). You will not need to perform any exercise during this test as the dobutamine drug simulates this.
The most common reasons for performing this test are:
- To assess for narrowings in the heart arteries (most common reason). The drug causes your heart to pump harder and faster and so it needs more blood supply. If there are significantly narrowed blood vessels, an area of the heart may not receive the required blood flow and not contract as well, which we can see with ultrasound.
- To assess narrowing of the aortic valve: valves are doors that open and close in the heart, allowing blood to flow in the correct direction. A narrowing of the valve is known as ‘stenosis’. In some cases of narrowing of the aortic valve (aortic stenosis) it is not clear whether the narrowing is significant or not. By exercising the heart with dobutamine it pumps more strongly and a more accurate assessment of the degree of the narrowing of the aortic valve can be made. This can then guide your treatment.
- To assess the heart muscle in patients with heart muscle disorders: assessing the ability of the heart muscle to pump more strongly when exercised with dobutamine can be helpful in the assessment and treatment of some heart muscle disorders, known as cardiomyopathies.
Eating and drinking before the test
Please do have a light meal before the test and avoid caffeine containing food or drink, such as tea, coffee and coke. Being well hydrated is however important so please drink plenty of water before the test.
Do I still take my medications?
PLEASE READ CAREFULLY
Certain medications must be stopped for 48 hours before the test (i.e. do not take on the morning of the test or the day before) as these medications can hinder exercise. If you have taken them within 48 hours prior to the test, the test will not be performed.
THE DRUGS THAT MUST BE STOPPED FOR 48 HOURS ARE:
- Beta-blockers: Atenolol, Propranolol, Nebivolol, Bisoprolol, Carvedilol, Metoprolol
What happens when I arrive at the hospital?
Please report to the reception desk to check you in.
You will be asked to sit in a chair in the waiting area until you are called in to have the scan.
After being called into the scan room, a doctor or sonographer will come and see you to explain the test and then will ask you to sign a consent form agreeing to have the test.
You will be asked some questions and you will be given time to ask questions.
Before your procedure you’ll be asked to remove all clothing from the top half of your body as the test can only be performed on a bare chest. Please wear suitable clothing.
A small plastic tube (cannula) will be inserted into a vein in your arm or hand through which all the injections will be given.
Occasionally we may need to administer a contrast agent (dye) in through the cannula to see the heart more clearly. This is not the same contrast that is used in CT scans and does no harm to the kidneys, but people can very rarely be allergic to this.
How is the DSE done?
The DSE takes approximately 40-60 minutes to complete. It is performed lying on your left side.
You will have your blood pressure and heart tracing (ECG) monitored and the first pictures of the heart will be taken whilst you are resting. The scan is painless and performed by placing some gel on the chest and moving a small handheld probe over the skin.
Once the first pictures are taken, the dobutamine infusion can start. You will be connected to a pump delivering a controlled drip of dobutamine into the cannula in your hand or arm. The aim is to increase your heart rate to a certain level known as the ‘target heart rate’. Once we are at this point, we can be sure that we are exercising the heart enough to answer the question that the doctor is looking into. If the dobutamine alone does not allow the heart to reach the ’target heart rate’ a second drug called atropine may be given from a needle in your hand or arm to increase the heart rate to the target.
Dobutamine, atropine and the contrast solution are rapidly destroyed and removed by the body, so their effects are short-lived.
Are there risks to having the procedure?
Most people have no difficulties with the procedure. There are very small risks due to the fact that the heart is being exercised with a drug, however overall, the test is very well-used and very safe.
The most common sensation is the feeling of the heart pumping strongly and sometimes feeling flushed, but these fully resolve within minutes of stopping the dobutamine drug.
The risks of the stress echo are chest tightness, shortness of breath and an abnormal heart rhythm as well as a smaller risk of a heart attack.
The medicines used may cause an allergic reaction during the test. If you have had allergic reactions to any medicine before, please tell the doctor before the test. An allergic reaction can range from a rash with itchiness to throat swelling, or anaphylaxis.
Atropine can in some patients cause blurring of vision and dry mouth for short time.
What happens after the test?
Once the test is completed you will be able to change back into your top garments. You will be asked to return to the chair in the waiting area for 15 to 30 minutes for observation and then are able to go home.
Will I know the results of the test?
The doctor or sonographer who performed the examination will review the images recorded and the full report will be sent to your referring specialist who will then contact you and your GP to decide further management.
Contact information:
If you have any questions about your planned dobutamine stress echocardiogram, please contact (Monday to Friday, 9:00am to 4:30pm):
Diagnostic Cardiology – ECG Department (Chelsea and Westminster Hospital)
- Tel: 020 33153443 / 5
Diagnostic Cardiology – ECG and ECHO Department (West Middlesex University Hospital)
- Tel: 020 8560 5336
This leaflet was written by:
Teresa Rutigliano (Senior Chief Cardiac Physiologist)
Reviewed and approved by:
Dr G Sunthar Kanaganayagam
Consultant Cardiologist and Cardiology Imaging Lead