Dobutamine stress echoDobutamine stress echoDobutamine stress echoDobutamine stress echo

MAHMOUD SOLIMAN,MDMAHMOUD SOLIMAN,MD20122012

Why stress???

•Why echo????

•Why dobutamine???

Why stress????????

•Myocardial ischaemia results from supply demand mismatch leading to cascade of events

Cont.•Metabolic changes

•Diastolic dysfunction

•Wall motion abnormalities

•ECG changes

•Chest pain

Chest pain is the tip of iceberg

•Advanced degrees of coronary obstruction may exist without manifestations of ischaemia at rest

Why echo??????•Many patients can not perform

physical stress

•Many patients have abnormal resting ECG

•LT BBB

IVCD

Why Dobutamine????•Dobutamine is a synthetic

catecholamine with direct B1 receptor agonist effect

•Also mild B2 & Alpha 1 agonist effect

•There are two types of stressors•A-Those induce or inhance

misdistributions of coronary blood flow eg.Dypridamole& adenosine

•B-Those increase myocardial oxygen demand eg. Dobutamine

•Many studies showed that dobutamine is more effective than dypyridamole in precipitating myocadial dysfunction & well suited for imaging modalties.

Test procedure

General considerations•Space

•Time

•Personnel

•Equipment

•Space: should be large enough to accommodate equipment & free movement of personnel especially in emergencies .

•Time :about 90 mins.

•Personnel :cardiologist & nurse

•Equipment: machine & crush trolly

Patient preparation•The test should be discussed with

the patient & written informed consent should be obtained.

•B.BLOCKERS,Ca Chanell blokers,Nitrates should be withdrawn 24hs before the test.

Dobutamine stress protocols

•Baseline recording of BP, 12 lead ECG & Standard views(Parasternal long&short,apical four& two).

•Dobutamine infused at 3-5 mins stages at increasing doses:5,10,20,30&40ug/kg/min

•Atropine 0.25-1 mg may also used

•DOBUTAMINE ECHOCARDIOGRAM _ ECHOCARDIOGRAPHIE DE STRESS NORMAL - YouTube.flv

Segmental wall motion abnormalities

16 segments model•1>>>>>>>>>>>>>>>>>>>>NORMAL

•2>>>>>>>>>>>>>>>>>>>>HYPOKINETIC•3>>>>>>>>>>>>>>>>>>>>AKINETIC

•4>>>>>>>>>>>>>>>>>>>>DYSKINETIC•5>>>>>>>>>>>>>>>>>>>>ANEURYSMAL

Clinical implications of DSE

•1-Diagnosis of CAD

•Sensitivity >>>>> 80%

•Specificity >>>>> 80%

•2-Assessment of post infarct patients

•Assessment of viability

•Assessment of inducible ischaemia

•3-Perioperative assessment of pts undergoing major vascular syurgery

•4 -Assessment of ps with valvular diseases:

•a- aortic stenosis with impaired LV FUNCTION

•B-mitral stenosis•C-Asymptomatic mitral &aortic

regurge

•5-Assessment of pts with dilated myopathy

•Idiopathic•ischaemic

Complications

•

International stress echo complications

registry•From 1998-2004

•35103 case•63 serious side

effects(death,infarction,VF)

•EVENT RATE 1>>>>>>>557 CASES

MERCI

•THANK YOU