title: Pronounced unexplained preoperative tachycardia heralding serious cardiac events: a series of three cases.
abstract: OBJECTIVE
  Pronounced, unexplained preoperative tachycardia can be a formidable challenge for the anesthesiologist. Whereas the relationship between persistent intraoperative tachycardia and perioperative morbidity is indisputable, there is a lack of available data on unexplained preoperative tachycardia. The main objective of this case series is to stimulate research and discussion on this topic, so that guidelines can be developed to aid in management.
  
  
  METHODS
  We present three patients with pronounced (> or = 130 beats x min(-1)) unexplained preoperative tachycardia who suffered adverse perioperative events that were garnered from quality improvement records at two teaching hospitals. In the first case, a 38-yr-old woman with a lumbar spinal tumour went into ventricular fibrillation after induction of anesthesia and was found on subsequent evaluation to have an abnormal cardiac re-entrant pathway. In the second case, an otherwise healthy middle-aged man developed a wide complex tachycardia with hypotension during foot surgery, with the subsequent cardiac evaluation being negative. In the third case, a young, healthy woman scheduled for a melanoma incision developed crushing, substernal chest pain accompanied by nausea and shortness of valve prolapse with regurgitation. Before rescheduling the procedures, therapeutic interventions were undertaken that facilitated successful completion of the surgeries.
  
  
  CONCLUSIONS
  There are currently no data regarding the prevalence of unexplained preoperative tachycardia, and no guidelines to direct management. More research is needed on this important topic, including epidemiological data and management algorithm(s).
authors.affiliation: Department of Anesthesiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. scohen40@jhmi.edu
authors.forename: Steven P
authors.initials: SP
authors.lastname: Cohen
authors.forename: Christopher
authors.initials: C
authors.lastname: Kent
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D002637:Chest Pain / Q000209:etiology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005528:Foot / Q000601:surgery; D005592:Fracture Fixation; D006331:Heart Diseases / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000601:surgery; D007431:Intraoperative Complications / Q000503:physiopathology*; D008297:Male; D008545:Melanoma / Q000601:surgery; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000503:physiopathology; D008945:Mitral Valve Prolapse / Q000150:complications / Q000503:physiopathology; D013125:Spinal Neoplasms / Q000601:surgery; D013610:Tachycardia / Q000150:complications* / Q000503:physiopathology; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000503:physiopathology; D014693:Ventricular Fibrillation / Q000503:physiopathology