You have been asked to attend to have a Dobutamine Stress Echocardiogram (DSE).

What is a Dobutamine Stress Echocardiogram (DSE)?

A Dobutamine stress echocardiogram (DSE) is an ultrasound scan of the heart taken while you are exercising with a drug called Dobutamine. Dobutamine copies exercise and lets us to see how the heart responds to performing exercise (stress). You will not need to do any exercise during this test as the Dobutamine drug simulates this.

The most common reasons for doing this test are:
  • To look for narrowing in the heart arteries (most common reason). The drug causes your heart to pump harder and faster so it needs more blood supply. If there are significantly narrowed blood vessels, an area of the heart may not get the blood flow it needs and will not contract as well. We can see this with ultrasound.
  • To look for narrowing of the aortic valve. Valves are doors that open and close in the heart letting blood flow in the right 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 if the narrowing is significant or not. By exercising the heart with Dobutamine it pumps more strongly allowing a better assessment of the narrowing of the aortic valve. This can then guide your treatment.
  • To look for the heart muscle in patients with weak heart muscle disorders. Assessing how the heart muscles pump more strongly when exercised with Dobutamine can be helpful. It will guide the treatment of some heart muscle disorders, known as cardiomyopathies.
How is the DSE done?
  • The DSE takes about 40 - 60 minutes to do. You will be lying on your left side.
  • You will have your blood pressure and heart tracing (ECG) monitored. The first pictures of the heart are taken at rest to give us a baseline.  This is to exclude certain contraindications for the test. It assesses the quality of the image to carry out the test.  There is a minority of patients where their images will not let us carry out the test accurately.  The scan is painless and performed by placing some gel on the chest and moving a small handheld probe over the skin.
  • When the first pictures are taken the Dobutamine infusion will start. You will be connected to a pump that gives a controlled drip of Dobutamine into a small plastic tube (cannula) in your hand or arm. The aim is to increase your heart rate to a certain level known as the ‘target heart rate’. When 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 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 test?

Most people have no problem with this test. There are very small risks due to the fact that the heart is being exercised with a drug. Overall the test is usually well-tolerated and very safe. The most common sensation is the feeling of the heart pumping strongly and sometimes feeling flushed. These fully settle within minutes of stopping the drug.

The risks of the stress echo are:

  • chest tightness
  • shortness of breath
  • abnormal heart rhythm
  • a very small risk of a heart attack

The drugs used may cause an allergic reaction during the test. If you have had allergic reactions to any medicine before please tell the doctor or nurse before the test. An allergic reaction can range from an itchy rash to throat swelling or anaphylaxis.

In some patients Atropine can cause blurred vision and dry mouth for short time.  We recommend not to drive for around 3 hours after Atropine or until blurred vision has gone.

Eating and drinking before the test

Have a light meal before the test. Avoid caffeine drinks like tea, coffee and coke. Being well hydrated is important so please drink plenty of water before the test.

Do I still take my medications?

Please read carefully 

Some drugs must be stopped for 48 hours (2 full days) before the test as these medications can hinder exercise. If you have taken them within 48 hours before the test it will not be done.

The drugs that must be stopped for 48 hours are

Do not take the following drugs 2 full days before the test and on the day:

  • Beta-blockers: Atenolol, Propranolol, Nebivolol, Bisoprolol, Carvedilol, Metoprolol

You can use your GTN as normal if you have some angina.  Medication can start as normal after the test. 

What happens when I arrive at the hospital?

A specialist nurse will come and see you to explain the test. You will be asked to sign a consent form agreeing to have the test. You will be asked some questions. You will also be given time to ask questions.

Before your test you will be asked to remove all clothing from the top half of your body. The test can only be done on a bare chest. Please wear suitable clothing.  A towel will be provided to cover your chest if needed.

A small plastic tube (cannula) will be inserted into a vein in your arm or hand. All injections will be given through this.

We may need to give you a dye (contrast agent) through the cannula to see the heart more clearly. This is not the same thing that is used in CT scans and does no harm to the kidneys.  People can very rarely be allergic to this.

What happens after the test?

When the test is finished you will be able to change back into your clothes and the cannula will be removed. You may be asked to return to the chair in the waiting area for 15 minutes for observation. After that you can go home.

Will I know the results of the test?

The doctor or sonographer who did the test will review the images recorded. The full report will be sent to your referring specialist who will then contact you and your GP to decide what happens next.

Contact information

If you have any questions about your planned Dobutamine Stress Echocardiogram, please contact Monday to Friday, 9:00am to 4:00pm

  • Cardiology Department Tel: 01228 814295
  • Cardiology Secretary Tel: 01946 523005

Confidentiality

‘The Trust’s vision is to keep your information safe in our hands.’ We promise to use your information fairly and legally, and in-line with local and national policies. You have a right to understand how your information is used and you can request a copy of the information we hold about you at any time.

For further information on confidentiality contact the Information Governance Team:

Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

pals@ncic.nhs.uk | 01228 814008 or 01946 523818

If you would like to raise a complaint regarding your care, please contact the Complaints Department:

complaints@ncic.nhs.uk | 01228 936302