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Smruti S. Nalawadi, Kirsten Tolstrup, Olivera Cuk, Takahiro Shiota, Swaminatha V. Gurudevan, Robert James Siegel, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, Atropine as an adjunct to supine bicycle stress echocardiography: an alternative strategy to achieve target heart rate or rate pressure product, European Heart Journal - Cardiovascular Imaging, Volume 13, Issue 7, July 2012, Pages 612–616, https://doi.org/10.1093/ejechocard/jer268
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Abstract
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.
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.
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.