title: Recurrent ST-segment elevations in a patient without significant coronary disease.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Surugadai Nihon University Hospital, Tokyo 101-8309, Japan. ryoiida@beach.ocn.ne.jp
authors.forename: Ryoji
authors.initials: R
authors.lastname: Iida
authors.forename: Seiji
authors.initials: S
authors.lastname: Yazaki
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saeki
authors.forename: Setsuro
authors.initials: S
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D003329:Coronary Vasospasm / Q000503:physiopathology*; D004562:Electrocardiography; D005743:Gastrectomy; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology; D012008:Recurrence