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Dobutamine Stress Echocardiogram Turnberg Building Cardiology 0161 206 2031 © G15121005W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2015. Document for issue as handout. Unique Identifier: CS81(15). Review date: December 2017 Rate control drugs that must be stopped 2 days (48 hours) before the test Beta Blockers (Stop 3 days (72 hours) prior to test if you are a dialysis patient) Atenolol (Tenormin, Co-tenidone, Tenoret) Bisoprolol (Cardicor, Emcor) Carvedilol(Eurcardic) Acebutelol(Sectral) Nebivolol (Nebilet) Metoprolol(Lopresor) Propranolol (Inderal, Half Inderal) Nadalol(Corguard) Oxprenolol (Trasicor, Trasidrex) Sotalol (Sotacor, Beta-Cardone) Calcium Channel Blockers Verapamil (Securon, Univer, Cordilax, Vertab, Verapress) Diltiazem (Tildiem, Adizem, Angitil, Dilcardia, , Slozem, Viazem) Sinus Node Inhibitor Ivabradine(Procoralan) What is a Dobutamine Stress Echocardiogram (DSE) and why do I need one? A Stress Echocardiogram is an ultrasound test to look at your heart muscle at rest and during ‘stress’ when it is beating faster (as if you have been exercising). We usually ‘stress’ your heart with a drug called dobutamine given via a drip in one of the veins in your arm. The main reason for doing this test is to look at the impact of reduced blood flow to the main pumping chamber of the heart when it is being made to beat faster and pump harder. This will help us to determine whether or not, you have significant narrowing in the arteries of the heart that may be responsible for your symptoms. The stress echocardiogram can also be performed to look for how other heart abnormalities which may be affecting the heart function such as problems with your heart valves. Do I need to do anything before the test? Confirmation: There is an enormous demand for these tests and it is important for you to confirm your appointment by leaving a message on: 0161 206 4746 Arriving without confirmation may cause you to be turned away as your appointment will be given to another patient. It also helps the doctor responsible for your care to decide what would be the best management for your heart condition. 1 © G15121005W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2015. Document for issue as handout. Unique Identifier: CS81(15). Review date: December 2017 2 Are there any alternatives? If you have been referred by your doctor or specialist clinician to have a stress echocardiogram, the reason for this test and the alternatives should have been explained and talked through with you before you were referred. Exercise Treadmill (Stress) Test You may have already had an exercise test. A stress echocardiogram may be requested by your doctor or specialist clinician if an exercise test is unhelpful or impossible. It is also performed if your doctor needs more detailed information than that provided by a standard exercise test. Myocardial Perfusion Scan (Myoview Scan) This test uses a radio-isotope agent to assess the circulation of your heart during rest and stress. It is used to help to determine whether you may have significant heart artery narrowing(s) and whether your symptoms are angina. 3 What will happen on the day? We do not currently perform stress myoview at Salford Royal in patients with asthma or other lung related breathing problems. Therefore a dobutamine stress echo is performed in this group of patients. Clothing: Medication: Whilst this test does not need you to have any sedation or any anaesthetic drugs, we would strongly recommend that you arrange for someone to drive you home or to go home in a taxi and not go home on public transport or walk home. Please stop taking the medications listed on page 1 of this leaflet 2 days (48 hours) before the test and stop betablockers 3 days (72 hours) prior to test if you are a dialysis patient. All these medications slow the heart beat and do not allow us to complete the test. It is important that you continue to take ALL your other medications. If you use a nitrolingual spray / tablets (GTN) or inhalers you should bring these with you to the appointment. You should also bring a list of all your medications that you are taking. Please wear your normal clothes but you will be asked to remove upper clothing. We provide hospital gowns to all patients. You should attend the: Echo Room, Heart Care Unit Travel: Please speak to the secretary about this if this will be a problem when you telephone to confirm the appointment. Eating and drinking: You may eat and drink as normal before coming for your test. as this is where the test will be performed. Please use the central car park if coming by car. Patients with restricted mobility may wish to use Entrance 6. Please note there is an appropriate waiting area and nearby WRVS cafe for family or friends accompanying you. You will be weighed and asked to lie on the echocardiogram couch. Either a doctor or a specialist nurse will explain the procedure to you and go through a set of routine questions. © G15121005W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2015. Document for issue as handout. Unique Identifier: CS81(15). Review date: December 2017 4 How long does it take? Your blood pressure will be checked and monitored throughout the procedure. If it is too high we may decide to postpone the test until it is at an acceptable level. Your ECG will also be continually monitored throughout the procedure. Your heart rate will be gradually increased by a drug through the drip called Dobutamine. In this case a letter would be sent to your GP to let him/her know to alter your medications. An additional drug called Atropine may be given to help speed the heart rate up further if required. You will have a drip inserted into a vein in your arm (usually in the fold of your left elbow). The first part of the test is a brief check echocardiogram (ultra sound scan of the heart). This will allow us to obtain important information about your heart pumping chambers and valves. The echocardiogram will be repeated at intervals throughout the procedure to check the functioning of the main pumping chamber. 5 The maximum target heart rate is based on your age and is generally lower than what is aimed for during a standard treadmill test. A third solution called a ‘contrast agent’ is also given through the same drip which helps the doctor to view your heart chambers more clearly. When your target heart rate is reached all the drugs are stopped and we keep monitoring your heart rate and blood pressure until everything is back to normal. Overall the whole appointment time is about 45 minutes. The ‘preparation time’ is around 15 minutes. The main procedure where your heart is scanned and the drugs to speed up your heart rate are given lasts about 12-15 minutes. The recovery time until everything is back to normal is also about 15 minutes. What happens after the test? The senior doctor will explain the test results to you immediately after the procedure and will then write to your GP and the Doctor or clinician who referred you for the test. The effects of the Dobutamine drug will have worn off by the time you are ready to go home. If the drug Atropine was used, the effects (mainly a dry mouth) will take longer. Are there any risks or side effects? Most patients report very few side effects and tolerate the test very well. The main feeling is an awareness of your heart ‘racing’ It feels rather strange because you are not exercising, but your heart is. The drugs can make you feel a tingling sensation on your face and scalp, a feeling you want to pass urine, flushing, a dry mouth and occasionally you may feel a little sick. These are normal and these minor side effects quickly wear off when the drug is stopped. If you are having a stress echocardiogram as part of an investigation into chest pain, this may be provoked during the test. If this happens we may stop the test and the symptoms usually resolve very quickly. You can also use your nitrolingual (GTN) spray if you wish. © G15121005W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2015. Document for issue as handout. Unique Identifier: CS81(15). Review date: December 2017 6 For further information: Serious side effects are very rare in our practice but may include a bad attack of angina or palpitations. If this occurs we start appropriate treatment and occasionally we may recommend admission to hospital to monitor your heart, even if just for a short while. IF YOU HAVE ANY QUERIES ABOUT THE TEST YOU SHOULD LEAVE YOUR NAME AND CONTACT NUMBER ON: 0161 206 2031 Notes http://www.patient.co.uk http://www.bhf.org. uk/living_with_a_ heart_condition/tests/ echocardiogram Endorsements: Dr Nik Abidin Consultant Cardiologist Dr Peter Woolfson Consultant Cardiologist Mr Brian Parr Nurse Clinician (Advanced Practitioner) IF YOU CANNOT TELEPHONE OR IF YOU WOULD PREFER TO EMAIL US, CONTACT: angela.smith@srft. nhs.uk WE WILL THEN CALL OR EMAIL YOU BACK 7 © G15121005W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2015. Document for issue as handout. Unique Identifier: CS81(15). Review date: December 2017 8 © G15121005W. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2015 This document MUST NOT be photocopied Information Leaflet Control Policy: Unique Identifier: CS81(15) Review Date: December 2017 For further information on this leaflet, it’s references and sources used, please contact 0161 206 2031 If you need this interpreting please telephone Copies of this information are available in other languages and formats upon request. In accordance with the Equality Act we will make ‘reasonable adjustments’ to enable individuals with disabilities, to access this treatment / service. Email: [email protected] Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on 0161 206 1779 Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD If you would like to become a Foundation Trust Member please visit: If you have any suggestions as to how this document could be improved in the future then please visit: Telephone 0161 789 7373 www.srft.nhs.uk/ for-members http://www.srft.nhs.uk/ for-patients www.srft.nhs.uk