You can find further information on the following websites:
www.nhsdirect.nhs.uk (or telephone NHS Direct on 0845 4647)
www.bse.org British Society of Echocardiography
www.bhf.org.uk
Or you may telephone the British Heart Foundation Heart
Information Line on 08450708070
Dobutamine Stress Echocardiography (DSE)
If you require translation for this Leaflet, please contact:
The Cardiology Department, Wycombe Hospital, Queen Alexandra
Rd, High Wycombe, Bucks HP11 2TT.
Contact details: Gemma Bennett 01494 425902 or Sandra Francis
01494 425903
Information for Patients
www.buckinghamshirehospitals.nhs.uk
Date of Publication: August 2008
Review Date: August 2010
Leaflet code:
Disclaimer
This leaflet explains the principles behind DSE and what you may
experience during the procedure. It is not, however, comprehensive
and should be used in conjunction with consultation with your
doctor.
Leaflet produced by Melanie Kirk, Cardiology Department,
Wycombe Hospital
Department of Cardiology
Cardiac Imaging
Version 1.0
Introduction
Dobutamine Stress Echocardiography (DSE) is a test that will allow
your cardiologist (heart specialist) to assess the function of your
heart and whether it receives an adequate blood supply under
stress. It can be used to diagnose or assess coronary artery
disease. It is also useful in assessing whether certain parts of the
heart are permanently damaged after a heart attack or whether
some recovery is possible. The test involves performing an
echocardiogram (heart scan) and giving a drug into a vein
(dobutamine) that mimics the effects of exercise on the heart. A
DSE is helpful in evaluating existing coronary artery disease. It is
often used on patients who cannot perform a treadmill test due to
arthritis or other physical limitations. It is also useful when the
results of the treadmill test do not give us the answers we need.
In this leaflet we explain some of the aims, benefits and risks of this
procedure. We want you to be fully informed about the procedure
and your choices so that you can be involved in making any
decisions. Please ask about anything you do not understand or
wish to have explained in more detail. You can change your mind
about having the procedure at any time.
What preparation do I need?
If you are on any of the following medications they should be
stopped 48 hours before the appointment time. This is because all
these medications slow the heart.
Bisoprolol
Cardicor, Emcor, Monocor
Sotalol
Beta-cardone, Sotacor
Atenolol
Tenorim, Co-tenidone, Kalten, Tenoret 50
Tenoretic, Beta-adelat,Tenif.
Acebutol
Sectral, Secadrex
Metoprolol
Beatloc, Lopresor, Co-betaloc
Carvedilol
Eucardic
Celiprolol
Celectol
Labetolol
Trandate
Pindolol
Viskaldix
Propranolol
Inderal, Inderal LA, Cardinol, Cardinol LA
Nadolol
Corgard
Nebivolol
Nebilet
Oxprenolol
Trasicor, Trasidex, Slow-Trasicor
Timolol
Betim, Moducren, Prestim
Diltiazem
Tildiem, Adizem-SR, Adizem-XL, Antigel SR,
What is an echocardiogram (heart scan)?
An echocardiogram is a diagnostic test that uses ultrasound to take
images of your heart. You will be asked to remove all clothing from
the waist up and asked to lie on your left-hand side on a special
couch. Gel will be applied to your chest and a small probe moved
over the skin to view your heart from different angles. High
frequency sound waves are transmitted into the body and “echoes”
are received back onto the monitor showing the internal structure of
your heart. Ultrasound does not use X-rays and it can be safely
performed on adults, children and babies. There is no risk to
unborn babies.
Antigil-XL, Calcocard CR, Dilcardia SR, Dilzem SR
Dilzem XL, Slowzem, Tildiem, Viazem, Zemtard
Verapamil
Cordilox, Securon, Half-Securon, Secron SR,
Univer, Verapress MR, Vertab SR
Ivabradine
Procoralan
You should not eat for 2 hours prior to the test. You may take your
regular medications (with the exception of those mentioned above)
at their usual time with a little water.
If you use a nitrolingual (GTN spray) you should take this with you
to the appointment.
Bring a list of your medications.
Wear loose and comfortable clothes and dress so you can easily
remove all clothing from the waist up. You may like to bring a
newspaper or book.
Your blood pressure will be checked on arrival and monitored
throughout the test. If it is too high the doctor may decide to
postpone the test until it is at an acceptable level.
What happens when I arrive at the hospital?
On arrival you should report to the Cardiac Day Unit which is
located on the upper ground floor of Wycombe Hospital. Go
through the double-doors and the nurse’s station is on your righthand side. Hand your appointment letter to a member of staff and
you will be shown where to wait.
What does the procedure involve? How long does it last? What
does it feel like?
It is possible to mimic the effects of exercise on the heart by
injecting a medicine called dobutamine into a vein. Before the
dobutamine is administered you will have an echocardiogram (see
above). After the echocardiogram the dobutamine will be given by
continuous infusion (drip) through a vein in your arm. This will
slowly increase your heart rate in a controlled way. The rate of the
dobutamine infusion will be increased every three minutes until you
have reached your target heart rate which is determined by your
age. Your blood pressure and heart rate will be carefully monitored
throughout the test. It is sometimes necessary to give an additional
drug called atropine to help you reach your target heart rate. Once
you have attained your target heart rate a further scan will be
performed. Following this the infusion of dobutamine will be
stopped.
Depending on the reason for the test you may have an additional
scan performed soon after the infusion of dobutamine has begun.
The procedure may take up to one hour to complete. However
factors such as schedule delays or emergencies may delay the
start of your procedure or prolong the length of it.
What happens after the procedure?
Once the procedure has been completed you will continue to be
monitored until your heart rate returns to normal. A cardiac nurse
will check on you regularly. We will then remove the cannula (small
tube) from your arm and you may get dressed.
Do I need someone with me when I go home?
Although the effects of the test should have worn off by the time
you leave the hospital, it is recommended that you should have a
friend or relative drive you home.
You may resume your usual diet and activities after the test. The
medication may leave you feeling weak for a short period. This will
soon pass.
Are there any potential risks or complications?
A small number of patients may experience minor side-effects.
These include headache, nausea and tingling (in fingers, feet or
head). These effects usually wear off two to three minutes after the
drug has been stopped. If atropine was administered you may
experience some blurred vision and a dry mouth.
You may also notice symptoms that you would have otherwise
developed during normal exercise such as chest pain, palpitations
or breathlessness. These usually go away once the test is
terminated. If you experience any chest pain (or tightness),
breathing difficulties or palpitations during the test, you should
notify staff immediately.
Potential risks from the procedure are rare, but include
complications from the cannula site (bruising or infection), rhythm
disturbances of the heart (fewer than 1% of cases), heart attack or
stroke (rare: fewer than 1 in 1000 cases).
The test is performed regularly in this hospital and the likelihood of
a serious event occurring is very low.
How can I help to reduce Healthcare Associated Infections?
Keeping you hands clean is an effective way of preventing the
spread of infections. We ask that you, and anyone accompanying
you, use the hand rub (special gel) available at the main entrance
of the hospital and at the entrance to every ward before coming into
and after leaving the hospital. In some situations hands may need
to be washed at a sink using soap and water rather than the hand
rub. Staff will let you know if this is the case.
For infection control purposes and to keep you safe and well
visitors are requested not to:



Accompany you if they are unwell
Sit on your bed or use the patient toilets
Touch your wounds, or any medical devices, drips or
catheters.
When will I be told the results?
We will explain the results of the test as soon as the procedure is
completed. It may be that you will need to attend an outpatient
appointment in order to discuss the treatment options. A full copy of
the report will be sent to the doctor who asked for the test.
Who can I contact if I have any more questions?
If you have any questions or worries about the procedure, please
contact Gemma Bennett in the first instance. Her direct line is
01494 425902.