dobutamine stress echo
TRANSCRIPT
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Dobutamine stress echoDobutamine stress echoDobutamine stress echoDobutamine stress echo
MAHMOUD SOLIMAN,MDMAHMOUD SOLIMAN,MD20122012
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Why stress???
•Why echo????
•Why dobutamine???
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Why stress????????
•Myocardial ischaemia results from supply demand mismatch leading to cascade of events
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Cont.•Metabolic changes
•Diastolic dysfunction
•Wall motion abnormalities
•ECG changes
•Chest pain
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Chest pain is the tip of iceberg
•Advanced degrees of coronary obstruction may exist without manifestations of ischaemia at rest
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Why echo??????•Many patients can not perform
physical stress
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•Many patients have abnormal resting ECG
•LT BBB
IVCD
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Why Dobutamine????•Dobutamine is a synthetic
catecholamine with direct B1 receptor agonist effect
•Also mild B2 & Alpha 1 agonist effect
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•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
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•Many studies showed that dobutamine is more effective than dypyridamole in precipitating myocadial dysfunction & well suited for imaging modalties.
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Test procedure
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General considerations•Space
•Time
•Personnel
•Equipment
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•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
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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•B.BLOCKERS,Ca Chanell blokers,Nitrates should be withdrawn 24hs before the test.
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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
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•DOBUTAMINE ECHOCARDIOGRAM _ ECHOCARDIOGRAPHIE DE STRESS NORMAL - YouTube.flv
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Segmental wall motion abnormalities
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16 segments model•1>>>>>>>>>>>>>>>>>>>>NORMAL
•2>>>>>>>>>>>>>>>>>>>>HYPOKINETIC•3>>>>>>>>>>>>>>>>>>>>AKINETIC
•4>>>>>>>>>>>>>>>>>>>>DYSKINETIC•5>>>>>>>>>>>>>>>>>>>>ANEURYSMAL
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Clinical implications of DSE
•1-Diagnosis of CAD
•Sensitivity >>>>> 80%
•Specificity >>>>> 80%
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•2-Assessment of post infarct patients
•Assessment of viability
•Assessment of inducible ischaemia
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•3-Perioperative assessment of pts undergoing major vascular syurgery
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•4 -Assessment of ps with valvular diseases:
•a- aortic stenosis with impaired LV FUNCTION
•B-mitral stenosis•C-Asymptomatic mitral &aortic
regurge
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•5-Assessment of pts with dilated myopathy
•Idiopathic•ischaemic
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Complications
•
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International stress echo complications
registry•From 1998-2004
•35103 case•63 serious side
effects(death,infarction,VF)
•EVENT RATE 1>>>>>>>557 CASES
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MERCI
•THANK YOU