Letter to the Editor

Electroconvulsive Therapy-associated Acute Coronary Syndrome in the Absence of Coronary Artery Disease

Authors: Stephen M. Selkirk, MD, PhD

Abstract

Electroconvulsive therapy (ECT)-related cardiac complications have been documented extensively in the literature and include circulatory collapse, arrhythmias, hypertensive responses, transient left ventricular dysfunction, and transient ST abnormalities. The rate of ECT-induced cardiac complications has been estimated to be as high as 28%;1 however, many reports either do not delineate the degree of preexisting cardiac disease or include patients with known cardiac disease. Furthermore, no case report has demonstrated an elevation in cardiac-specific enzymes after ECT. I present a case in which a patient undergoing her 91st ECT session developed chest pain, elevated troponin levels, and transient T-wave inversion in the absence of angiographic coronary artery disease.

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References

1. Gerring JP, Shields HM. The identification and management of patients with a high risk for cardiac arrhythmias during modified ECT. J Clin Psychiatry 1982; 43: 140–143.
 
2. Dec GW Jr, Stern TA, Welch C. The effects of electroconvulsive therapy on serial electrocardiograms and serum cardiac enzyme values: A prospective study of depressed hospitalized inpatients. JAMA 1985; 253: 2525–2529.
 
3. Betriu A, Pare JC, Sanz GA, et al. Myocardial infarction with normal coronary arteries: A prospective clinical-angiographic study. Am J Cardiol 1981; 48: 28–32.
 
4. Jones RM, Knight PR. Cardiovascular and hormonal responses to electroconvulsive therapy: Modification of an exaggerated response in an hypertensive patient by β-receptor blockade. Anaesthesia 1981; 36: 795–799.