Electroconvulsive therapy--induced hemodynamic changes unmask unsuspected coronary artery disease
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G B Knos1, Y F Sung, R C Cooper
1Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA.
Insights
Electroconvulsive therapy (ECT) can cause cardiac events in patients with underlying coronary artery disease. Careful cardiac evaluation is crucial before ECT to prevent myocardial ischemia and ensure patient safety during treatment.
Area of Science:
- Cardiology
- Neurology
- Psychiatry
Background:
- Electroconvulsive therapy (ECT) induces significant hemodynamic changes, including elevated heart rate and blood pressure, due to sympathetic nervous system activation.
- These transient physiological alterations can increase myocardial oxygen demand, potentially precipitating ischemic events in susceptible individuals.
Observation:
- A 64-year-old male with no prior cardiac history experienced chest pain and ECG changes post-ECT.
- Cardiac catheterization revealed significant coronary artery stenosis.
Findings:
- The patient underwent coronary artery bypass surgery before resuming ECT.
- This case highlights the potential for ECT to unmask undiagnosed coronary artery disease.
Implications:
- Thorough cardiac pre-screening is essential for patients undergoing ECT, particularly those with risk factors.
- Understanding ECT's cardiovascular effects is critical for safe clinical practice and patient management.
Abstract:
Electroconvulsive therapy (ECT) is known to produce increases in heart rate and blood pressure during seizure activity due to sympathetic stimulation and systemic catecholamine surges. These intense, brief hemodynamic changes can adversely affect myocardial oxygen supply and demand. In patients with compromised myocardial circulation, ECT can unmask undiagnosed cardiac disease. In this case report, ECT was performed on a 64-year-old white male with negative cardiac history. The patient awakened complaining of chest pain and ST wave depression was noted on the electrocardiogram. Cardiology consultation and cardiac catheterization were followed by coronary artery bypass surgery for significant coronary artery stenosis prior to resumption of ECT treatments. The physiological changes that occur during ECT are discussed, as well as pitfalls in evaluation of these patients for ECT treatment.