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Published on: March 27, 2018
Stunned myocardium after hip arthroplasty
M Mizogami1, K Shimo, T Taguchi
1Department of Anaesthesiology, Asahi University, Gifu-ken, Japan.
Insights
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.
Abstract:
We report a case of ST-segment elevation occurring in all leads of the ECG during hip arthroplasty. It is thought that this resulted from a stunned myocardium because wall motion abnormalities were reversible, there was no evidence of fixed or vasospastic coronary occlusion and there was only a slight increase in serial cardiac enzymes. Treatment with nicorandil improved the patient's cardiac function. A [123I]MIBG test revealed a high myocardial washout rate, suggesting that the stunned myocardium was caused by exposure to excessive norepinephrine induced by anaesthesia or surgery.
