J Dent Anesth Pain Med.  2018 Jun;18(3):189-193. 10.17245/jdapm.2018.18.3.189.

Recurrent ST segment elevations in a patient with asymptomatic early repolarization during head and neck surgery: implications of vasospastic angina

• Park SU
• Kim SH
• Kwon HM
• Koh GH
• Nam GB
• Karm MH
• Kim WJ
• Ku SW

• KMID: 2415184
• DOI: http://doi.org/10.17245/jdapm.2018.18.3.189

Abstract

A 57-year-old woman scheduled for cochlear implant removal exhibited preoperative electrocardiographic findings of early repolarization (ER). Four episodes of transient ST segment elevations during surgery raised suspicion for vasospastic angina (VA). In the post-anesthetic care unit, the patient complained of chest discomfort and received sublingual nitroglycerin with uncertain effect. The patient refused to proceed with postoperative invasive coronary angiography, resulting in inconclusive diagnosis. Intraoperative circumstances limit the diagnosis of VA, which emphasizes the need for further testing to confirm the diagnosis. When VA is suspected in patients with underlying ER, it is reasonable to consider invasive examination to establish the diagnosis and prevent recurrence of VA. If ST changes are observed during surgery in patients with preoperative ER, careful monitoring is recommended. Due to general anesthesia, the absence of patient symptoms limits the definitive diagnosis of those with suspected VA. Therefore, additional postoperative surveillance is recommended.

Keyword

Early Repolarization; Recurrent ST Elevation; Vasospastic Angina

MeSH Terms

Anesthesia, General
Cochlear Implants
Coronary Angiography
Diagnosis
Electrocardiography
Female
Head*
Humans
Middle Aged
Neck*
Nitroglycerin
Recurrence
Thorax
Nitroglycerin

Figure

• 

  Fig. 1 12-lead surface electrocardiography (25 mm/s, 10 mm/mV) demonstrating early repolarization pattern in leads II, III and aVF. Arrows indicate slurred QRS complex and J point.

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  Fig. 2 Intraoperative ST segment elevations with vital signs. (A) Four episodes of ST segment elevations on lead II. (B) Heart rate. (C) Systolic blood pressure.

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  Fig. 3 Electrocardiographic morphology transition during surgery. (A) Electrocardiographic morphology of slurred pattern without ST elevation. (B) Electrocardiographic morphology of notched pattern during ST elevation. The arrow indicates notch with elevated J point.

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