title: The management and outcome of documented intraoperative heart rate-related electrocardiographic changes.
abstract: OBJECTIVE
  The authors analyzed surgical cases in which electrocardiographic (ECG) signs of cardiac ischemia were noted to be precipitated by increases in heart rate (ie, heart rate-related ECG changes [REC]). The authors aimed to find REC incidence, specificity for coronary artery disease (CAD), and the outcome associated with different management strategies.
  
  
  METHODS
  A retrospective review.
  
  
  METHODS
  A university hospital, tertiary care.
  
  
  METHODS
  Patients undergoing surgery under anesthesia.
  
  
  METHODS
  A chart review.
  
  
  METHODS
  The authors searched 158,252 anesthesia electronic records for comments noting REC (ie, ST-segment or T-wave changes). After excluding cases with potentially confounding conditions (eg, hypotension, hyperkalemia, and so on), 26 cases were analyzed.
  
  
  RESULTS
  REC commonly was precipitated by anesthesia-related events (ie, intubation, extubation, and treatment of bradycardia). In 24 cases, REC was managed by prompt heart rate reduction using β-blocker agents, opioids, and/or cardioversion in the addition to the removal of stimulus. Only 1 case had a copy of the ECG printed. Two cases were aborted, 1 was shortened and 23 proceeded without change. Postoperative troponin T levels were checked, and cardiology consultation was obtained in selected cases and led to further cardiac evaluation in 6 cases. Postoperative myocardial infarction developed in only 1 patient in whom the ECG changes were allowed to persist throughout the case.
  
  
  CONCLUSIONS
  This incidence of reported REC was much lower than the previously reported incidence of ischemia-related ECG changes, suggesting that the largest proportion of events go unnoticed. In many patients, subsequent cardiology workup did not confirm the existence of clinically significant CAD.
authors: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
authors: Ion A
authors: IA
authors: Hobai
authors: Cosmin
authors: C
authors: Gauran
authors: Hovig V
authors: HV
authors: Chitilian
authors: Jesse M
authors: JM
authors: Ehrenfeld
authors: John
authors: J
authors: Levinson
authors: Warren S
authors: WS
authors: Sandberg
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D001794:Blood Pressure / Q000502:physiology; D001919:Bradycardia / Q000150:complications / Q000628:therapy; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000628:therapy; D007431:Intraoperative Complications / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011183:Postoperative Complications / Q000628:therapy; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists