title: Atropine as an adjunct to supine bicycle stress echocardiography: an alternative strategy to achieve target heart rate or rate pressure product.
abstract: OBJECTIVE
  To investigate the use of atropine to achieve target heart rate (THR) and rate pressure product (RPP) during supine bicycle exercise stress echocardiography (SBESE) to increase the number of diagnostic stress tests.
  
  
  RESULTS
  Forty-four patients that were unable to achieve THR or RPP during SBESE performed to evaluate ischaemia were given 0.4-1.2 mg of atropine to augment THR and RPP. After atropine (0.7 ± 0.3 mg) the maximum heart rate (HR) achieved was 133 (± 16) bpm, mean THR was 82% (± 8%), and average RPP was 22 716 (± 4915) b/min × mmHg. Of the patients with a non-diagnostic SBESE, with the use of atropine 80% of those patients achieved a diagnostic test. There were no major adverse affects from the administration of atropine.
  
  
  CONCLUSIONS
  The use of atropine to augment the HR or RPP during SBESE (i) is safe; (ii) enables the assessment of ischaemia at peak effort; and (iii) allows assessment of exercise haemodynamics in patients with sub-maximal exercise capacity and chronotropic incompetence.
authors.affiliation: Cardiac Noninvasive Laboratory,  Cedars-Sinai Medical Center, 8700 Beverly Blvd, Room 5623, Los Angeles 90048, CA,  USA.
authors.forename: Smruti S
authors.initials: SS
authors.lastname: Nalawadi
authors.forename: Kirsten
authors.initials: K
authors.lastname: Tolstrup
authors.forename: Olivera
authors.initials: O
authors.lastname: Cuk
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shiota
authors.forename: Swaminatha V
authors.initials: SV
authors.lastname: Gurudevan
authors.forename: Robert James
authors.initials: RJ
authors.lastname: Siegel
mesh_terms: D001285:Atropine; D001794:Blood Pressure / Q000187:drug effects*; D002316:Cardiotonic Agents; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016683:Supine Position
chemical_list: D002316:Cardiotonic Agents; D001285:Atropine