1
|
Miller A, Amouri H, Makhoul M, Medalion B, Shamgar O, Lessik J, Ronen G, Feldman T, Shiller Y, Caspi O. Myxoma embolization during electroconvulsive therapy. An unusual presentation. J Stroke Cerebrovasc Dis 2024; 33:107916. [PMID: 39142609 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 07/27/2024] [Accepted: 08/02/2024] [Indexed: 08/16/2024] Open
Abstract
We describe a comatose female patient after electroconvulsive therapy. Head imaging showed diffuse cerebral emboli. Transesophageal echocardiography showed left atrial myxoma which was resected soon thereafter. The article describes the presentation, complications and treatment of myxomas and discusses electroconvulsive therapy, its adverse events and the possible relation to myxoma embolization.
Collapse
Affiliation(s)
- Asaf Miller
- Medical Intensive Care Unit, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Hanna Amouri
- Medical Intensive Care Unit, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Maged Makhoul
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Benjamin Medalion
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ofer Shamgar
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Psychiatry, Rambam Health Care Campus, Haifa, Israel
| | - Jon Lessik
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Galia Ronen
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Radiology, Rambam Health Care Campus, Haifa, Israel
| | - Tzah Feldman
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Pathology Laboratory, Rambam Health Care Campus, Haifa, Israel
| | - Yizhak Shiller
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Oren Caspi
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| |
Collapse
|
2
|
Hermida AP, Mohsin M, Marques Pinheiro AP, McCord E, Lisko JC, Head LW. The Cardiovascular Side Effects of Electroconvulsive Therapy and Their Management. J ECT 2022; 38:2-9. [PMID: 34699395 DOI: 10.1097/yct.0000000000000802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Electroconvulsive therapy (ECT) remains stigmatized in the broader medical community because of misunderstandings about treatment procedures, mortality rates, and cardiovascular complications. Electroconvulsive therapy causes periprocedural hemodynamic variability because of the surges in parasympathetic and sympathetic nervous systems after the administration of the electrical charge. Patients experience an increase in cardiac workload, which is potentially dangerous for patients with preexisting heart disease. Several findings suggest that cardiac complications occur most frequently in patients with underlying cardiovascular disease. We describe the cardiovascular complications that may result from ECT treatment and offer insight on how to mitigate these concerns if they occur. PubMed was queried using terms "electroconvulsive therapy" and "cardiovascular adverse effects." A table is provided with the common cardiovascular side effects of ECT and the most recent evidence-based treatment strategies to manage them. Generally, ECT is a safe procedure in which complications are minor and manageable. Most major complications caused by ECT are related to the cardiovascular system; however, with an appropriate pre-ECT evaluation and a comprehensive multidisciplinary team approach, the cardiovascular complications can be well managed and minimized. Providing proper cardiac clearance can prevent cardiac complications and provide timely care to treatment-resistant populations who are at risk for excessive morbidity and suicide.
Collapse
Affiliation(s)
- Adriana P Hermida
- From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Mamoona Mohsin
- Department of Psychiatry and Behavioral Medicine, Charleston Area Medical Center/West Virginia University, Charleston, West Virginia
| | - Ana P Marques Pinheiro
- From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Elizabeth McCord
- From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - John C Lisko
- Division of Cardiology, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Lyndsay W Head
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
3
|
Electroconvulsive Therapy Is Safe in a Patient With Punctate Inner Chorodiopathy. J ECT 2020; 36:e49. [PMID: 32453187 DOI: 10.1097/yct.0000000000000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
4
|
Grover S, Aggarwal S. Recurrent ventricular tachycardia during the electroconvulsive therapy procedure: A case report. Indian J Psychiatry 2020; 62:222-224. [PMID: 32382190 PMCID: PMC7197835 DOI: 10.4103/psychiatry.indianjpsychiatry_412_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 10/05/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
| | - Shivali Aggarwal
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
| |
Collapse
|
5
|
Takagi S, Terasawa Y, Takeuchi T. Asystole a Few Seconds After the Electrical Stimulation of Electroconvulsive Therapy. PSYCHOSOMATICS 2018; 60:66-69. [PMID: 29776678 DOI: 10.1016/j.psym.2018.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Shunsuke Takagi
- Department of Psychiatry, Samariyabito Hospital, Okinawa, Japan.
| | - Yuuya Terasawa
- Department of Psychiatry, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Takashi Takeuchi
- Department of Psychiatry, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| |
Collapse
|
6
|
Singh NM, Sathyaprabha TN, Malthish K, Thirthalli J, Andrade C. Early and late postictal cardiac electrophysiological changes associated with low, moderate, and high dose electroconvulsive shocks. Asian J Psychiatr 2018; 33:78-83. [PMID: 29547752 DOI: 10.1016/j.ajp.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/28/2018] [Accepted: 03/01/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies have examined the effects of electroconvulsive therapy (ECT) on human cardiac electrophysiology. However, no study has so far examined whether these effects vary with the magnitude of the electrical dose used to elicit the seizure. Because the benefits and adverse effects of the ECT seizure are dose-dependent, we examined the effects of different electrical doses of electroconvulsive shocks (ECS) on cardiac electrophysiology in an animal model with a view to determine whether cardiac electrophysiology could be a useful proxy to evaluate the quality of the ECT seizure. METHODS Adult female Wistar rats (n = 20/group) received sham, low dose (10 mC), moderate dose (18 mC), or high dose (25 mC) ECS. The electrocardiogram (ECG) was recorded and was analyzed for time and frequency domain variables in 30 s epochs in preictal (30 s before ECS), early postictal (starting 15 s after stimulation) and late postictal (5 h after ECS) periods. RESULTS ECS was associated with substantial changes in most time and frequency domain measures during the early postictal period; a strong parasympathetic effect was observed. However, the effects of different ECS doses did not differ for any variable. All changes returned to levels that were similar to those of the sham controls in the late postictal period. CONCLUSIONS The effect of ECS on time and frequency domain cardiac electrophysiological measures was not dose-dependent. This suggests that if higher electrical doses are associated with stronger central seizures, ECG-derived variables may not be useful proxies for the quality of the central seizure. The generalization of this conclusion from animal to clinical contexts requires study.
Collapse
Affiliation(s)
- Nagendra Madan Singh
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, 560 029, India.
| | - T N Sathyaprabha
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore, 560 029, India.
| | - Kashyap Malthish
- Department of Electrical Engineering, Linköping University, Linköping, Sweden.
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560 029, India.
| | - Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, 560 029, India.
| |
Collapse
|