DIAGNOSIS OF MYOCARDIAL INJURY BY REAL-TIME RECORDING OF ST SEGMENTS OF THE ELECTROCARDIOGRAM IN A PATIENT RECEIVING GENERAL-ANESTHESIA FORELECTROCONVULSIVE-THERAPY

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.