DIAGNOSIS AND MANAGEMENT OF ISCHEMIC-HEART-DISEASE IN THE PATIENT SCHEDULED TO UNDERGO ELECTROCONVULSIVE-THERAPY

The cardiovascular risk of electroconvulsive therapy (ECT) is a produc t of the stress of ECT itself and the severity and stability of corona ry artery disease (CAD), as well as other cardiovascular factors. ECT itself represents a relatively low-risk procedure. Patient-specific ri sk can be defined by a combination of clinical evaluation and noninvas ive testing, much of which is aimed at detecting the presence and stag ing the severity and stability of CAD. Patients at high risk of a card iac complication include those with severe or unstable symptoms of CAD , and they should undergo extensive cardiac evaluation before ECT. Pat ients at low risk likely need no further evaluation and can undergo EC T. Patients at intermediate risk should have careful clinical evaluati on, and most likely noninvasive evaluation, which should include some form of stress testing. Medical therapy should be continued and/or max imized in all patients with CAD. It is expected that with careful scre ening, patients with established CAD can undergo ECT safely.