Postoperative electrocardiography changes: To worry or not to worry

IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Noninvasive Electrocardiology Pub Date : 2023-11-20 DOI:10.1111/anec.13092
Chihjen Lee MD, MPH, Janet Shin MD, Arash Bereliani MD, Liza Capiendo MD, Eiman Firoozmand MD, Roya Yumul MD, PHD, CHSE
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Abstract

Abnormal postoperative electrocardiograms are not uncommon, oftentimes leading to further cardiac workup especially when the findings are new and not easily explainable. A forty-year-old woman, with a history of left breast cancer status post bilateral mastectomies and reconstructions, presented for robot-assisted low-anterior resection secondary to rectal cancer. Postoperative electrocardiogram showed poor R wave progression, biphasic T waves in V2-4, and possible anterior wall ischemia. Her electrocardiogram from 6 years ago was normal. No recent electrocardiogram was available for comparison. Initially, the abnormal postoperative electrocardiogram appeared worrisome. However, the patient was completely asymptomatic, and all vital signs were normal. Cardiac point-of-care ultrasound showed normal parasternal long and short axis views. The biphasic T waves in V2-4 were suggestive of Wellens syndrome, but the accompanying poor R wave progression was not consistent with the diagnostic criteria. The anesthesiologist then remembered the patient's history of the presence of a left breast implant and suspected it might have caused the changes on the electrocardiogram. A literature search did find one publication that shows approximately 45% of patients with breast implants present with electrocardiogram changes, including poor R wave progression and negative T waves. Therefore, no further cardiac workup was ordered for our patient. She was discharged home 3 days later. Breast implants and electrocardiogram changes are a lesser-known topic. Obtaining a pre-operative electrocardiogram should be considered in patients with previous breast implants, to serve as a baseline for comparison if the patient were to need another electrocardiogram in the future.

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术后心电图变化:担心还是不担心。
术后心电图异常并不罕见,通常导致进一步的心脏检查,特别是当发现新发现且不容易解释时。一位40岁的女性,双侧乳房切除术和乳房重建后有左乳腺癌病史,提出了机器人辅助下直肠癌前低位切除术。术后心电图显示R波进展不佳,V2-4双相T波,可能前壁缺血。她六年前的心电图正常。没有最近的心电图可供比较。起初,术后心电图异常令人担忧。然而,患者完全无症状,所有生命体征正常。心脏护理点超声显示正常胸骨旁长、短轴视图。V2-4的双相T波提示Wellens综合征,但伴随的R波进展差不符合诊断标准。麻醉师记起了病人的左乳植入史,并怀疑这可能是导致心电图变化的原因。文献检索确实发现了一份出版物,显示大约45%的隆胸患者出现心电图改变,包括R波进展不良和T波阴性。因此,没有为我们的病人安排进一步的心脏检查。3天后她出院回家。隆胸和心电图改变是一个鲜为人知的话题。对于既往植入过乳房的患者,应考虑术前获得心电图,作为患者将来是否需要再次进行心电图比较的基线。
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来源期刊
CiteScore
3.40
自引率
0.00%
发文量
88
审稿时长
6-12 weeks
期刊介绍: The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation. ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.
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