title: Safety and cardiac chronotropic responsiveness to the early injection of atropine during dobutamine stress echocardiography in the elderly.
abstract: OBJECTIVE
  To determine the safety and cardiac chronotropic responsiveness to early atropine dobutamine stress echocardiography (DSE) in the elderly.
  
  
  METHODS
  Retrospective study of 258 patients >or= 70 years who underwent early atropine DSE and 290 patients >or= 70 years who underwent conventional DSE. In the early atropine protocol, atropine was started at 20 microg/kg/min of dobutamine if heart rate was < 100 beats/min, up to 2 mg. The cardiac chronotropic responsiveness in the elderly was compared with a control group of patients < 70 years matched for sex, myocardial infarction, diabetes, and treatment with beta blockers and calcium channel blockers.
  
  
  RESULTS
  The dose of dobutamine given to elderly patients was lower during early atropine than during conventional DSE (mean (SD) 29 (7) v 38 (4) microg/kg/min, p = 0.001). Early atropine DSE resulted in diminished incidence of ventricular extrasystoles, non-sustained ventricular tachycardia, bradycardia, and hypotension compared with conventional DSE. In comparison with patients < 70 years, elderly patients required lower doses of dobutamine and atropine and achieved a higher percentage of predicted maximum heart rate (92 (9)% v 88 (10)%, p = 0.0001). Except for more common hypotension (16% v 10%, p = 0.004), no other difference in adverse effects was observed between patients >or= 70 and < 70 years.
  
  
  CONCLUSIONS
  Early atropine DSE is a safe strategy in the elderly resulting in lower incidence of minor adverse effects than with the conventional protocol. Elderly patients presented adequate cardiac chronotropic responsiveness to early injections of atropine, requiring lower doses of drugs to reach test end points.
authors.affiliation: Echocardiography Laboratory, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil. jeanetsutsui@msn.com
authors.forename: J M
authors.initials: JM
authors.lastname: Tsutsui
authors.forename: F Cerqueira
authors.initials: FC
authors.lastname: Lario
authors.forename: D R
authors.initials: DR
authors.lastname: Fernandes
authors.forename: I
authors.initials: I
authors.lastname: Kowatsch
authors.forename: J C
authors.initials: JC
authors.lastname: Sbano
authors.forename: J A
authors.initials: JA
authors.lastname: Franchini Ramires
authors.forename: W
authors.initials: W
authors.lastname: Mathias
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000494:pharmacology*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D001285:Atropine / Q000009:adverse effects / Q000494:pharmacology*; D002316:Cardiotonic Agents; D003324:Coronary Artery Disease / Q000175:diagnosis*; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000889:Anti-Arrhythmia Agents; D002316:Cardiotonic Agents; D004280:Dobutamine; D001285:Atropine