[Usefulness of multi-lead electrocardiogram and transesophageal echocardiography for the detection and evaluation of intraoperative coronary spasm].
We describe a case of coronary spasm in a 59-year-old man undergoing an emergent abdominal aortic replacement for ruptured aortic aneurysm. The patient was brought to the operating room in a state of hypovolemic shock, and was successfully resuscitated through intensive volume expansion by rapid infusion devices. Twenty minutes after cross-clamping of the abdominal aorta, ST-segment elevation on the lead III of electrocardiogram (ECG) and dyskinesis in the inferior wall shown by transesophageal echocardiography (TEE) were noted. Coronary spasm was suspected, and isosorbide dinitrate was administered intravenously without delay, leading to prompt reversal of ischemic changes. A number of reports have suggested that care should be taken against coronary spasm in non-cardiac surgery as well as cardiac surgery, especially in patients with coronary risk factors. Monitoring by multi-lead ECG and TEE is a powerful method by which to detect and evaluate intraoperative myocardial ischemia.
Chang
Kyung-ho
KH
Department of Anesthesiology, Faculty of Medicine, University of Tokyo, Tokyo 113-8655.
Matsuo
Hideki
H
Ogawa
Makoto
M
Tamai
Hisayoshi
H
Itoh
Nobuko
N
Hayashida
Masakazu
M
Hanaoka
Kazuo
K
D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001019:Aortic Rupture / Q000601:surgery; D003329:Coronary Vasospasm / Q000175:diagnosis* / Q000188:drug therapy; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D004630:Emergencies; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000188:drug therapy; D007548:Isosorbide Dinitrate / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*
D007548:Isosorbide Dinitrate