thanx, we used dobutamine in cardiac units all the time in the hospital setting, but this is in an office and we have to titrate up to 40mcg/kg. some of the docs even then give atropine after the dobutamine, which has then made us use lopressor to get their heart rates back down. In the echo lab you can see the results of the dobutamine long before their heart rates go up, so depending on the doc, we may stop at peak if pictures are good. Just too many possible side effects at peak doses!