Comprehensive Dobutamine Stress Echo
Pre-test:
 Set up room and equipment for test.
 Check oxygen unit.
 Ensure supervising physician is available; patient should not eat or drink a large amount 2 hours
before the test.
 If patient is diabetic, they should have something small to eat or drink.
 Confirm patient identification.
 Review indication for appropriateness and the need to do additional images.
 Take cardiac history and a list of current medications: important to know if patient is taking
beta blockers.
 Ask about medication allergies.
 Obtain age, height, weight, resting blood pressure, heart rate and pre-test rhythm.
 Explanation given to patient with time to answer questions.
 Obtain verbal and written consent.
 Remind patient the test can be stopped if intolerable.
 Assist patient with undressing (if required) from the waist up and put on a gown, open in the
front.
 Remind patient to notify staff if having any symptoms.
 Connect 12-lead ECG so rhythm and S-T segment can be monitored throughout the test.
 Ensure a clear ECG signal for proper looping of digital images: very important for assessing wall
motion.
 Perform standing and supine resting ECGs for baseline.
 Premix dobutamine in IV mini bag.
 Calculate target heart rate according to patient age.
 Chart appropriate dosing for each stage of the test according to weight.
Test:
 Start intravenous with a flush line of N/S or D5W.
 Piggyback dobutamine mini bag into flush line; dobutamine line must be infused by pump, do
not start med until resting images taken.
 Capture resting images and store loops.
 Obtain Apical 4ch, Apical 2ch, ALAX optional, PLAX, and 3 SAX views.
 Use tissue harmonics, reduces artifacts and enhances borders.
 Perform resting Simpsons EF and LV dimensional measurements.
 Start medication as DSE protocol instructs, increasing every 3 minutes.
 Perform images at each stage, record rest, low dose, peak and post images into the protocol
preset in the ultrasound machine.
 Check patient’s blood pressure at each stage.
 Ask patient frequently whether they are having any symptoms.
 If within 10 beats of target heart rate in stage 5, try isometric exercises like hand squeezing or
leg rises to reach target—if not successful, give atropine as per protocol or physician’s orders.
 Turn medication off when target heart rate reached or other end point reached.
Post Test:
 Perform recovery ECG, blood pressure and heart rate and rhythm.
 Remove gel from chest, remove IV, apply pressure and bandage.
 Assist patient to get dressed (if needed).
 Assess patient for dizziness or lightheadedness; proceed to recovery area for observation.
 Have patient escorted via wheelchair to door to meet escort.
 Patient may eat and drink as soon as test completed.
Test End Points:
 Target heart rate reached or surpassed.
 Develops new regional wall motion abnormality at least moderate in severity.
 Maximum pharmacological dose and exercise completed.
 Unstable arrhythmias.
 Severe hypertension – systolic > 225 OR diastolic > 95 mmhg.
 Hypotension – systolic < 80 and patient symptomatic.
 Intolerable symptoms and patient requests test stopped.
Adverse Responses:
Potential Adverse Responses to Test
Actions
Moderate or severe chest pain/ angina






Stop medication
Notify physician
Assess vital signs
Apply oxygen and administer Nitroglycerine as per
physician’s orders
Obtain 12-Lead ECG
Image heart
Sustained Ventricular Arrhythmia (VT)




Stop medication
Notify physician
Assess patient responsiveness
If patient becomes unresponsive with sustained VT,
initiate CPR and call a code blue.
Palpitations (SVT)


Document symptoms and duration
Administer Betaloc as per physician’s orders
Tremors/Shivering

Usually seen with faster heart rates and resolves on
its own
Hold for observation

Headache/Nausea


Headache is common if patient is prone to
headaches, apply cool cloth to forehead
Frequent symptom with wall motion, stop
medication if wall motion seen
Sensation of need to urinate

Potential Adverse Responses to Test
Actions
Lightheadedness

Check B/P, if hypotensive, administer saline bolus as
per physician order
Atrial Fibrillation

Supervising physician should assess patient and
determine if patient requires being sent to ER to be
treated and monitored
Common in men, feeling will stop when medication
is stopped
Supervising cardiologist should be notified to assess patient before discharge.