Recurrent ST-segment elevations in a patient without significant coronary disease

We report a case of recurrent ST-segment elevations totaling 7 times over 3 hours during subtotal gastrectomy and the early postoperative period in a patient with no history of coronary artery disease. Possible contributing factors include cold stimulus, epidural anesthesia, and inadequate depth of...

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Bibliographic Details
Published in:Journal of clinical anesthesia 2005-08, Vol.17 (5), p.372-378
Main Authors: Iida, Ryoji, Yazaki, Seiji, Saeki, Shigeru, Ogawa, Setsuro
Format: Article
Language:English
Subjects:
Aged
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Angina pectoris
Biological and medical sciences
Cardiac arrest
Cardiovascular disease
Coronary artery spasm
Coronary Vasospasm - physiopathology
Coronary vessels
Electrocardiography
Gastrectomy
Heart attacks
Humans
Male
Medical sciences
Postoperative Complications - physiopathology
Recurrence
Ventricular fibrillation
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Summary:We report a case of recurrent ST-segment elevations totaling 7 times over 3 hours during subtotal gastrectomy and the early postoperative period in a patient with no history of coronary artery disease. Possible contributing factors include cold stimulus, epidural anesthesia, and inadequate depth of anesthesia. The first episode almost resulted in cardiac arrest and was treated with intravenous epinephrine. The second episode was associated with ventricular fibrillation, which was treated with defibrillation and intravenous verapamil. The third to the seventh episodes were successfully treated with intravenous nitrate. The electrocardiographic changes and postoperative coronary angiography were consistent with a clinical diagnosis of coronary artery spasm. This case suggests that coronary artery spasm is capable of occurring repeatedly in a cyclic pattern during perioperative periods.
ISSN:0952-8180
1873-4529
DOI:10.1016/j.jclinane.2004.08.013