Postoperative electrocardiography changes: To worry or not to worry.

Area of Science:

• Cardiology
• Medical Devices

Background:

• Abnormal postoperative electrocardiograms (ECGs) often prompt further cardiac investigation.
• A patient with a history of breast cancer and rectal cancer underwent surgery.

Observation:

• Postoperative ECG revealed poor R wave progression and biphasic T waves, suggesting anterior wall ischemia.
• The patient was asymptomatic with normal vital signs and cardiac ultrasound.
• These ECG changes were initially concerning but inconsistent with Wellens syndrome criteria.

Findings:

• A history of left breast implant was identified as a potential cause for the ECG abnormalities.
• Literature suggests approximately 45% of patients with breast implants exhibit ECG changes, including poor R wave progression and negative T waves.
• No further cardiac workup was deemed necessary due to the likely artifact from the breast implant.

Implications:

• Breast implants can cause electrocardiogram (ECG) changes that may be misinterpreted as cardiac ischemia.
• Establishing a baseline ECG prior to surgery in patients with breast implants is crucial for accurate interpretation of future ECGs.
• This case highlights the importance of considering patient history, including the presence of medical devices like breast implants, when interpreting ECG findings.