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The management and outcome of documented intraoperative heart rate-related electrocardiographic changes

Ion A Hobai1, Cosmin Gauran, Hovig V Chitilian

  • 1Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.

Journal of Cardiothoracic and Vascular Anesthesia
|July 5, 2011
PubMed

Insights

Heart rate-related ECG changes (REC) during surgery are often precipitated by anesthesia events. Prompt heart rate reduction effectively manages REC, with low rates of postoperative myocardial infarction and confirmed coronary artery disease.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Cardiac Electrophysiology

Background:

  • Electrocardiographic (ECG) signs of cardiac ischemia can be precipitated by heart rate increases, termed heart rate-related ECG changes (REC).
  • Understanding the incidence, specificity for coronary artery disease (CAD), and outcomes of REC is crucial for surgical patient management.

Observation:

  • A retrospective chart review of 158,252 anesthesia records identified 26 cases of REC.
  • REC was frequently triggered by anesthesia-related events such as intubation, extubation, and bradycardia treatment.

Findings:

  • Prompt management by reducing heart rate with beta-blockers, opioids, or cardioversion, alongside stimulus removal, resolved REC in 24 cases.
  • Only one patient developed postoperative myocardial infarction when REC persisted.
  • Subsequent cardiology evaluation confirmed clinically significant CAD in a minority of patients.

Implications:

  • The reported incidence of REC is lower than expected, suggesting many events may go unrecognized.
  • Effective management of REC can prevent adverse cardiac events during surgery.
  • REC may not always indicate significant underlying coronary artery disease, warranting careful diagnostic workup.
Abstract

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