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Electroconvulsive Therapy-Induced ECG Changes Simulating a Myocardial Infarction

Electroconvulsive Therapy-Induced ECG Changes Simulating a Myocardial Infarction Abstract • Electroconvulsive therapy (ECT) can produce various cardiac arrhythmias; however, to our knowledge, no other alterations have been described in the ECG. A 75-year-old woman was admitted to the Methodist Hospital in Brooklyn, NY, because of depression. She had had no cardiac symptoms and had been in good health. She was not receiving any medications. Physical examination showed no abnormalities. Findings from the routine laboratory tests, a chest roentgenogram, and the initial ECG were normal. In view of the severe depression, a series of ECTs were given to the patient during a two-week period. A repeated ECG showed deep T-wave inversions in leads I, II, III, aVF, and V1 to V6. The patient was completely asymptomatic. Serial enzyme determinations were normal. A brain scan, gated-pool scan, computed tomography scan of the head, and a technetium Tc 99m pyrophosphate scan were all normal. Serial ECGs showed a persistence of the deep T-wave inversions. There were no QRS changes. There was no evidence of a cerebral vascular accident or pericarditis. The T-wave changes in our patient were not due to a myocardial infarction. Thus, ECT can produce striking T-wave abnormalities in the ECG that can simulate an acute myocardial infarction. (Arch Intern Med 1983;143:1786-1787) References 1. Altschule MD: Further observations on vagal influences on the heart during electroshock therapy for mental disease. Am Heart J 1950;39:88-91.Crossref 2. Hejtmanck MD, Bankhead AJ, Hermann GR: Electrocardiographic changes following electroshock therapy in curarized patients. Am Heart J 1949;37:790-805.Crossref 3. Bankhead AJ, Torrens JK, Harris TH: The anticipation and prevention of cardiac complications in electroconvulsive therapy. Am J Psychiatry 1950;106:911-917. 4. Nowill WK, Wilson W, Borders R: Succinylcholine in electroshock therapy: II. Cardiovascular reactions. Arch Neurol Psychiatry 1954;71: 189-197.Crossref 5. Ippolito TL, Blier JS, Fox TT: Massive T wave inversion. Am Heart J 1954;48:88-94.Crossref 6. Burch GE, Meyers R, Abildskov JA: A new electrocardiographic pattern observed in cerebrovascular accidents. Circulation 1954;9:719-723.Crossref 7. Gould L, Reddy CVR, Singh B, et al: T wave changes with intermittent left bundle branch block. Angiology 1980;31:66-68.Crossref 8. Yanowitz F, Preston JB, Abildskov JA: Functional distribution of right and left stellate inervation to the ventricles: Production of neurogenic electrocardiographic changes by unilateral alteration of sympathetic tone. Circ Res 1966;18:416-428.Crossref 9. Porter RW, Kamikowa U, Greenhoot JH: Persistent electrocardiographic abnormalities experimentally induced by stimulation of the brain. Am Heart J 1962;69:815-819.Crossref 10. Mellville KK, Blum B, Skister HE, et al: Cardiac ischemic changes and arrhythmias induced by hypothalamic stimulation. Am J Cardiol 1963;12:781-791.Crossref 11. Kortweg GCT, Bocles J, Ten Cote J: Influence of stimulation of some subcritical areas in the electrocardiogram. J Neurophysiol 1957;20:100-107. 12. Gould L, Basili R, Reddy CVR: Utility of monitored electroconvulsive therapy apparatus. NY State J Med 1981;81:406-408. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Electroconvulsive Therapy-Induced ECG Changes Simulating a Myocardial Infarction

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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1983.00350090168028
Publisher site
See Article on Publisher Site

Abstract

Abstract • Electroconvulsive therapy (ECT) can produce various cardiac arrhythmias; however, to our knowledge, no other alterations have been described in the ECG. A 75-year-old woman was admitted to the Methodist Hospital in Brooklyn, NY, because of depression. She had had no cardiac symptoms and had been in good health. She was not receiving any medications. Physical examination showed no abnormalities. Findings from the routine laboratory tests, a chest roentgenogram, and the initial ECG were normal. In view of the severe depression, a series of ECTs were given to the patient during a two-week period. A repeated ECG showed deep T-wave inversions in leads I, II, III, aVF, and V1 to V6. The patient was completely asymptomatic. Serial enzyme determinations were normal. A brain scan, gated-pool scan, computed tomography scan of the head, and a technetium Tc 99m pyrophosphate scan were all normal. Serial ECGs showed a persistence of the deep T-wave inversions. There were no QRS changes. There was no evidence of a cerebral vascular accident or pericarditis. The T-wave changes in our patient were not due to a myocardial infarction. Thus, ECT can produce striking T-wave abnormalities in the ECG that can simulate an acute myocardial infarction. (Arch Intern Med 1983;143:1786-1787) References 1. Altschule MD: Further observations on vagal influences on the heart during electroshock therapy for mental disease. Am Heart J 1950;39:88-91.Crossref 2. Hejtmanck MD, Bankhead AJ, Hermann GR: Electrocardiographic changes following electroshock therapy in curarized patients. Am Heart J 1949;37:790-805.Crossref 3. Bankhead AJ, Torrens JK, Harris TH: The anticipation and prevention of cardiac complications in electroconvulsive therapy. Am J Psychiatry 1950;106:911-917. 4. Nowill WK, Wilson W, Borders R: Succinylcholine in electroshock therapy: II. Cardiovascular reactions. Arch Neurol Psychiatry 1954;71: 189-197.Crossref 5. Ippolito TL, Blier JS, Fox TT: Massive T wave inversion. Am Heart J 1954;48:88-94.Crossref 6. Burch GE, Meyers R, Abildskov JA: A new electrocardiographic pattern observed in cerebrovascular accidents. Circulation 1954;9:719-723.Crossref 7. Gould L, Reddy CVR, Singh B, et al: T wave changes with intermittent left bundle branch block. Angiology 1980;31:66-68.Crossref 8. Yanowitz F, Preston JB, Abildskov JA: Functional distribution of right and left stellate inervation to the ventricles: Production of neurogenic electrocardiographic changes by unilateral alteration of sympathetic tone. Circ Res 1966;18:416-428.Crossref 9. Porter RW, Kamikowa U, Greenhoot JH: Persistent electrocardiographic abnormalities experimentally induced by stimulation of the brain. Am Heart J 1962;69:815-819.Crossref 10. Mellville KK, Blum B, Skister HE, et al: Cardiac ischemic changes and arrhythmias induced by hypothalamic stimulation. Am J Cardiol 1963;12:781-791.Crossref 11. Kortweg GCT, Bocles J, Ten Cote J: Influence of stimulation of some subcritical areas in the electrocardiogram. J Neurophysiol 1957;20:100-107. 12. Gould L, Basili R, Reddy CVR: Utility of monitored electroconvulsive therapy apparatus. NY State J Med 1981;81:406-408.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Sep 1, 1983

References