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Stunned myocardium after hip arthroplasty
M Mizogami1, K Shimo, T Taguchi
1Department of Anaesthesiology, Asahi University, Gifu-ken, Japan.
British Journal of Anaesthesia
|May 24, 2000
Summary
ST-segment elevation during hip arthroplasty suggests stunned myocardium. Treatment with nicorandil improved cardiac function, likely due to anesthesia-induced norepinephrine exposure.
Area of Science:
- Cardiology
- Cardiac Surgery
- Anesthesiology
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical cardiac event.
- Perioperative myocardial stunning can occur during non-cardiac surgery.
- Hip arthroplasty presents unique anesthetic and surgical challenges.
Observation:
- A patient undergoing hip arthroplasty developed ST-segment elevation across all electrocardiogram (ECG) leads.
- Wall motion abnormalities were reversible, with minimal cardiac enzyme elevation and no fixed coronary occlusion.
- A [123I]MIBG test indicated a high myocardial washout rate.
Findings:
- The observed ST-segment elevation was attributed to stunned myocardium, not acute infarction.
- Reversible wall motion abnormalities and high myocardial [123I]MIBG washout suggest catecholamine-induced myocardial dysfunction.
- Treatment with nicorandil effectively improved cardiac function.
Implications:
- This case highlights a potential cause of ECG changes during hip arthroplasty.
- Excessive intraoperative norepinephrine may induce myocardial stunning.
- Nicorandil may be a therapeutic option for managing perioperative myocardial stunning.