TABLE 1.

Dipyridamole and adenosine stress echocardiography protocol

General methodology during stress echo	Perform 12 lead ECG in resting condition and each minute throughout examination. An ECG is continuously displayed on echo monitor. Cuff blood pression is measured in resting condition and at each stage.
Contraindications	Active bronchospasm. > or equal 2nd degree AV block. SBP <90 mm Hg. Use of methylxanthine. Remote history of reactive airway disease Chronic dipyridamole therapy, recent (<12 h) coffee, tea, chocolate ingestion. Avoid dipyridamole stress echocardiography in patients presenting severe bilateral carotid disease with unknown Willis polygon circulation, due to the potential risk of brain ischemia.
Echocardiography imaging acquisition	Assess the distal LAD artery and the CBF velocity (peak velocity) at rest and after starting dipyridamole/adenosine infusion. If possible, RCA and LCA can be visualized. Perform regional wall motion analysis at rest and at peak. Echocardiography is continued monitored and intermittently stored.
Standard dipyridamole protocol	Dipyridamole intravenous infusion of 0.84 mg/kg over 10 min in two separate infusions: 0.56 mg/kg over 4 min (“standard dose”), followed by 4 min of no dose and if still negative, an additional 0.28 mg/kg over 2 min. Atropine (doses of 0.25 mg up to 1 mg) can be administered
Rapid dipyridamole protocol	Dipyridamole 0.84 mg/Kg can be given over 6 min
Adenosine protocol	Adenosine can be infused at maximum dose of 140 µg/kg/min over 6 min
After stress	Aminophylline (240 mg iv) should be available for immediate use in case of an adverse event occurs and routinely used at the end of the test

Abbreviations: AV = atrio‐ventricular; CBF = coronary blood flow; ECG = electrocardiogram; LAD = left anterior descending; LCA = left coronary artery; RCA = right coronary artery; SBP = systolic blood pressure.