Dobutamine stress echocardiogram

About a dobutamine stress echo

An echocardiogram or ‘echo’ is a scan of your heart that uses ultrasound (high frequency sound waves) to produce pictures of the heart.

The scan is painless and does not use radiation.

During a dobutamine stress echo, we use heart medication (dobutamine) to make your heart work harder, imitating exercise. We take ultrasound images to assess how the function of your heart changes during stress.

Why we recommend a stress echo

We often use stress echocardiography to assess and diagnose angina (chest pain due to coronary heart disease).

It is a good way to see whether there is an adequate supply of blood to your heart muscle at rest and during stress.

We can also use it to assess certain heart valve problems. The test helps us decide what treatment or intervention to offer you.

Alternatives

Other imaging investigations are available. These include a CT scan, MRI scan or nuclear imaging. 

Your doctor has decided that a stress echo is the most appropriate for you. Speak to your doctor if you have questions.

Risks

Stress echocardiography is a safe procedure, but there are some side effects of the medication, and risks.

• Some patients do not feel anything unusual during the test. Some patients feel a tingling sensation in their scalp, head or neck. Some are aware of their heart beating more strongly and faster when we give them the stress medication.
• Some patients develop chest tightness or feel dizzy or sick. If you feel unwell, we can stop the test. Your symptoms will resolve quickly when we stop the medication.
• There is a small chance (around 1 in 100) of developing a minor heart rhythm problem during the test. This usually settles once we stop the medication.
• Serious risks are rare. There is a 1 in 2,000 chance of having a bad angina attack, heart attack or serious heart rhythm problem. There is a 1 in 10,000 chance of having an allergic reaction to the contrast agent (if used) during the test.

Preparing for your scan

Read the following information to prepare for your scan.

Medications

You may need to stop some of your medication 48 hours before the test. (For example if your test is on a Wednesday, do not take this medication on Monday, Tuesday or Wednesday).

Eating and drinking

You can eat and drink as normal on the morning of the test. Do not eat anything during the 2 hours before the test.

During your scan appointment

A stress echocardiogram usually takes around 30 to 45 minutes to complete. You can expect your appointment to last up to an hour in total.

The person performing the scan (the sonographer) will either be a cardiac physiologist or a doctor. They may be male or female. One or two other members of staff such as a nurse or a doctor will also be present.

You can expect the following during your appointment.

• We will take you into an echo room in the Cardiac Investigations Department, and explain the test to you. We will ask you to sign an electronic consent form. If you have any questions, you can ask them before we begin the scan.
• We will measure your weight so we can work out how much medication to give you.
• We will ask you to undress to your waist and put on a hospital gown that opens at the front. We will respect your privacy while you are getting changed. We will then ask you to lie on your left-hand side, on the echo couch.
• We will attach stickers to your chest and connect them to the echo machine to monitor your heart rate and rhythm. We will check your blood pressure regularly throughout the test. 
• We will insert a small plastic tube (called a cannula) into a vein in your arm. We will use this to give you medication during the test. We will remove the cannula before you leave the department.
• We will darken the room so that we can see the ultrasound images clearly.
• The sonographer will take images of your heart by placing an ultrasound probe covered with a small amount of gel on several areas of your chest. This enables them to look at your heart from different angles. They will record these images on the echo machine. We may give you an injection of ultrasound contrast to see your heart more clearly.
• Once we have obtained the baseline images, we will start the dobutamine infusion (delivery). Every few minutes we will increase the dose of dobutamine. Sometimes we use a second medication (called atropine) to help increase your heart rate to the required level.
• We may also ask you to do some handgrip exercise using a squeezy ball.
• Once your heart rate has reached the target and we have recorded all the images, we will stop the medication.

After the scan

We will monitor you in the echo room until your heart rate has returned to normal. We may then ask you to sit in the waiting room for 15 minutes. This is to make sure that you have fully recovered before you go home.

Your sonographer will write a report after the scan and will send this to the doctor who referred you for the test.

This doctor will contact you to give you the scan results, or will discuss them with you at your next appointment. 

We advise you to avoid caffeinated drinks (for example tea, coffee, energy drinks) or alcohol for 6 hours after the stress echocardiogram.

More information

For further NHS information, visit Echocardiogram

For British Heart Foundation information, visit Other types of echocardiogram