Dobutamine (Acute HF / Stress Echo)

How it works

It acts predominantly as a beta-1 adrenoceptor agonist, increasing myocardial contractility and heart rate; in stress echo this provoked increase in myocardial oxygen demand unmasks inducible ischaemia or assesses myocardial viability.

Prescribing in practice

• Administer only with continuous ECG, blood pressure and (in acute heart failure) ideally haemodynamic monitoring, as it is arrhythmogenic and can provoke tachyarrhythmias, hypotension and myocardial ischaemia.
• Effect can be blunted in patients on beta-blockers, and tolerance may develop with prolonged infusion.
• Correct hypovolaemia before starting and use a dedicated infusion line via an infusion device, titrating to clinical and haemodynamic response.

Monitoring

Monitor continuous ECG, heart rate, blood pressure and symptoms throughout the infusion, with cardiac output or echocardiographic response where indicated.

Counselling the patient

• During stress echo, tell the team immediately about chest pain, palpitations or breathlessness.
• Palpitations and a pounding heartbeat are expected effects while the infusion runs and settle once it stops.

Evidence & guidelines

Dobutamine stress echocardiography is an established guideline-supported modality for assessing inducible ischaemia and myocardial viability.