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Ventricular fibrillation during rectal examination.

D W Munter1, R Stoner

  • 1Department of Emergency Medicine, Naval Hospital Camp Lejeune, NC 28542.

The American Journal of Emergency Medicine
|January 1, 1989
PubMed
Summary
This summary is machine-generated.

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A digital rectal examination triggered ventricular fibrillation in a 74-year-old man, leading to a non-transmural myocardial infarction. This case highlights potential cardiac risks associated with rectal exams, even in acute myocardial infarction patients.

Area of Science:

  • Cardiology
  • Gastroenterology

Background:

  • Rectal examinations are clinically indicated for various conditions, including gastrointestinal/genitourinary complaints, unexplained hypotension or anemia, trauma, neurological deficits, and before anticoagulation or thrombolytic therapy.
  • While controlled studies show no adverse effects in acute myocardial infarction patients, case reports document arrhythmias like bradycardia and ventricular fibrillation during rectal exams.

Observation:

  • A 74-year-old male developed ventricular fibrillation during a digital rectal examination.
  • The patient was resuscitated and showed cardiac enzyme elevation without ECG changes, indicative of a nontransmural myocardial infarction.

Findings:

  • The exact cause of rectal examination-induced arrhythmias is debated, with theories including increased vagal tone from parasympathetic innervation or sympathetic stimulation due to anxiety and catecholamine release.

Related Experiment Videos

  • This case suggests a potential link between digital rectal examination and serious cardiac events, such as ventricular fibrillation and myocardial infarction.

    • Implications:

    • Clinicians should exercise caution and consider patient-specific factors when deciding on rectal examinations, especially in those with pre-existing cardiac conditions.
    • While indicated in specific scenarios, the potential for iatrogenic cardiac arrhythmias necessitates a careful risk-benefit assessment for each patient.
    • Further research may be warranted to elucidate the mechanisms and prevalence of cardiac arrhythmias associated with digital rectal examinations.