Dobutamine stress echo
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Transcript of Dobutamine stress echo
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•B.BLOCKERS,Ca Chanell blokers,Nitrates should be withdrawn 24hs before the test.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