Atropine in Dobutamine stress echo

Q: 64 year old female with past medical history (PMH) of hypertension (HTN) was admitted overnight to ICU with chest pain. This morning she underwent Dobutamine stress echocardiography. While writing her progress note you noted atropine was given while in the ECHO lab? (select one)

A) Patient 'coded' in the echo suite with bradycardia
B) Atropine is a regular part of Dobutamine stress echo



Answer: B

Atropine is frequently used in Dobutamine stress echocardiography to achieve target heart rate. Atropine is used in divided doses of 0.5 mg to a total of 2.0 mg. Atropine increases the sensitivity of dobutamine echocardiography in patients who are chronically on beta-blockers (BB). Another maneuver which can be applied to achieve target heart rate with or without atropine is to use a sustained isometric hand grip in the late stages of the dobutamine protocol as a supplement to achieve peak heart rate.

#cardiology


References:

1. McNeill AJ, Fioretti PM, el-Said SM, et al. Enhanced sensitivity for detection of coronary artery disease by addition of atropine to dobutamine stress echocardiography. Am J Cardiol 1992; 70:41. 

2. Fioretti PM, Poldermans D, Salustri A, et al. Atropine increases the accuracy of dobutamine stress echocardiography in patients taking beta-blockers. Eur Heart J 1994; 15:355.

3. Ling LH, Pellikka PA, Mahoney DW, et al. Atropine augmentation in dobutamine stress echocardiography: role and incremental value in a clinical practice setting. J Am Coll Cardiol 1996; 28:551.