DIAGNOSIS OF MYOCARDIAL INJURY BY REAL-TIME RECORDING OF ST SEGMENTS OF THE ELECTROCARDIOGRAM IN A PATIENT RECEIVING GENERAL-ANESTHESIA FORELECTROCONVULSIVE-THERAPY
La. Steiner et al., DIAGNOSIS OF MYOCARDIAL INJURY BY REAL-TIME RECORDING OF ST SEGMENTS OF THE ELECTROCARDIOGRAM IN A PATIENT RECEIVING GENERAL-ANESTHESIA FORELECTROCONVULSIVE-THERAPY, Anesthesiology, 79(2), 1993, pp. 383-388
ELECTROCONVULSIVE therapy (ECT) is associated with short-lasting but i
mportant changes in autonomic nervous system activity.1-3 The autonomi
c response to ECT is characterized by initial parasympathetic stimulat
ion immediately followed by subsequent sympathetic stimulation. Typica
lly, transient bradycardia is first seen immediately after the seizure
, after which sinus tachycardia and arterial hypertension are observed
, frequently associated with cardiac arrhythmias.2-4 Though these chan
ges usually are self-limited, a hyperdynamic state in most elderly pat
ients represents an important risk factor.5 Hypotension after ECT warr
ants an immediate search for a cause. In this case report, we present
arterial hypotension immediately after ECT with subsequent refractory
myocardial failure and subendocardial infarction. We made the initial
diagnosis of myocardial injury because a tabulated record of real-time
ST-segment data was available at the bedside, allowing immediate deci
sions about appropriate pharmacologic support measures. To validate th
e observations in this patient, we also present data on ST segments of
the electrocardiogram (ECG) and hemodynamic variables recorded during
the first treatment in a comparison group of ten patients with the ad
mission diagnosis of depression who presented for ECT.