title: [Cardiac safety of electroconvulsive therapy in an elderly patient--a case report].
abstract: Since electroconvulsive therapy (ECT) was introduced as treatment for psychiatric disorders in 1938, it has remained one of the most effective therapeutic methods. ECT is often used as a "treatment of last resort" when other methods fail, and a life-saving procedure in acute clinical states when a rapid therapeutic effect is needed. Mortality associated with ECT is lower, compared to the treatment with tricyclic antidepressants, and comparable to that observed in so-called minor surgery. In the literature, cases of effective and safe electroconvulsive therapy have been described in patients of advanced age, with a burden of many somatic disorders. However, cases of acute cardiac episodes have also been reported during ECT. The qualification of patients for ECT and the selection of a group of patients at the highest risk of cardiovascular complications remains a serious clinical problem. An assessment of the predictive value of parameters of standard electrocardiogram (ECG), which is a simple, cheap and easily available procedure, deserves special attention. This paper reports a case of a 74-year-old male patient treated with ECT for a severe depressive episode, in the context of cardiologic safety. Both every single ECT session and the full course were assessed to examine their impact on levels of troponin T, which is a basic marker of cardiac damage, and selected ECG parameters (QTc, QRS). In the presented case ECT demonstrated its high general and cardiac safety with no negative effect on cardiac troponin (TnT) levels, corrected QT interval (QTc) duration, or other measured ECG parameters despite initially increased troponin levels, the patient's advanced age, the burden of a severe somatic disease and its treatment (anticancer therapy).
authors.affiliation: Medical University of Lublin, Poland: I Department of Psychiatry, Psychotherapy and Early Intervention; Department of Clinical Neuropsychiatry.
authors.forename: Hanna
authors.initials: H
authors.lastname: Karakuła-Juchnowicz
authors.affiliation: Medical University of Lublin, Poland: I Department of Psychiatry, Psychotherapy and Early Intervention.
authors.forename: Michał
authors.initials: M
authors.lastname: Próchnicki
authors.affiliation: Medical University of Lublin, Poland: I Department of Psychiatry, Psychotherapy and Early Intervention.
authors.forename: Paweł
authors.initials: P
authors.lastname: Kiciński
authors.affiliation: Medical University of Lublin, Poland: II Departament of Psychiatry and Psychiatric Rehabilitation.
authors.forename: Marcin
authors.initials: M
authors.lastname: Olajossy
authors.affiliation: Medical University of Lublin, Poland: I Department of Psychiatry, Psychotherapy and Early Intervention.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Pelczarska-Jamroga
authors.affiliation: Medical University of Lublin, Poland: I Department of Psychiatry, Psychotherapy and Early Intervention.
authors.forename: Michał
authors.initials: M
authors.lastname: Dzikowski
authors.affiliation: Medical University of Lublin, Poland: Departament of Family Medicine.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Jaroszyński
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D003866:Depressive Disorder / Q000628:therapy*; D015716:Electrocardiography, Ambulatory; D004565:Electroconvulsive Therapy / Q000009:adverse effects*; D006331:Heart Diseases / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D008297:Male; D020107:Troponin T / Q000378:metabolism
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: ECG; cardiac safety; elderly; electroconvulsive therapy