title: [Bezold-Jarisch reflex in a patient undergoing endoscopic sympathectomy for management of refractory angina pectoris: a case report].
abstract: OBJECTIVE
  Ischemic cardiomyopathy is characterized by imbalance between supply and demand of myocardial oxygen. Endoscopic transthoracic sympathectomy is a therapeutic option indicated in refractory cases. However, the patient's position on the operating table may favor ischemic coronary events triggering the Bezold-Jarisch reflex.
  
  
  METHODS
  A female patient, 47 years old, with refractory ischemic cardiomyopathy, admitted to the operating room for endoscopic transthoracic sympathectomy, developed the Bezold-Jarisch reflex with severe bradycardia and hypotension after placement in semi-sitting position to the procedure.
  
  
  CONCLUSIONS
  Bradyarrhythmia, hypotension, and asystole are complications potentially associated with patient placement in a semi-sitting position, particularly in cases with previous ischemic heart disease.
authors.affiliation: Hospital Universitário Getúlio Vargas, CET Integrado do Instituto de Anestesiologia do Amazonas, Manaus, AM, Brasil. Electronic address: wendell_caldas@yahoo.com.br.
authors.forename: Wendell Jackson de Macêdo
authors.initials: WJM
authors.lastname: Caldas
authors.affiliation: Hospital Universitário Getúlio Vargas, CET Integrado do Instituto de Anestesiologia do Amazonas, Manaus, AM, Brasil; Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brasil.
authors.forename: Maíra Ferreira
authors.initials: MF
authors.lastname: Barbosa
authors.affiliation: Hospital Universitário Getúlio Vargas, CET Integrado do Instituto de Anestesiologia do Amazonas, Manaus, AM, Brasil.
authors.forename: Cremilda Pinheiro
authors.initials: CP
authors.lastname: Dias
mesh_terms: D000787:Angina Pectoris / Q000601:surgery*; D001919:Bradycardia / Q000209:etiology*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D007431:Intraoperative Complications / Q000209:etiology*; D008875:Middle Aged; D056888:Patient Positioning / Q000009:adverse effects*; D012021:Reflex, Abnormal; D056152:Respiratory Rate; D013562:Sympathectomy / Q000379:methods*
keywords: Bezold‐Jarisch reflex; Cardiomiopatia isquêmica; Endoscopic transthoracic sympathectomy; Ischemic cardiomyopathy; Reflexo de Bezold‐Jarisch; Simpatectomia transtorácica endoscópica
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