Acute “Pseudoischemic” ECG Abnormalities after Right Pneumonectomy

Abstract

New onset of electrocardiographic (ECG) abnormalities can occur after lung surgery due to the changes in the position of structures and organs in the chest cavity. The most common heart rhythm disorder is atrial fibrillation. So-called “pseudoischemic” ECG changes that mimic classic ECG signs of acute myocardial ischemia are also often noticed. We report the case of a 68-year-old male, with no prior cardiovascular disease, who underwent extensive surgical resection for lung cancer. On a second postoperative day, clinical and electrocardiographic signs of acute myocardial ischemia occurred. According to clinical course, diagnostic procedures, and therapeutic response, we excluded acute coronary syndrome. We concluded that physical lesion of the pericardium, caused by extended pneumonectomy with resection of the pericardium, provoked the symptoms and ECG signs that mimic acute coronary syndrome. Our final diagnosis was postpericardiotomy syndrome after extended pneumonectomy and further treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) was recommended. It is necessary to consider possibility that nature of ECG changes after extended pneumonectomy could be “pseudoischemic.”

Reversible, regional ST‐segment elevation due to chylothorax

“…Pericarditis has been documented after extensive pneumonectomy that violates the pericardium (Tamarappoo and Klein, 2016 ; Vasic et al., 2017 ). However, this patient underwent an extrapericardial pneumonectomy, which indicates an alternative mechanism of pericardial inflammation.…”

Evaluation of electrocardiographic parameters in patients who had lung resections

“…These electrophysiological changes may appear as life-threatening arrhythmias [2]. This usually occurs as a result of lung resection, which impacts a significant part of the mediastinal space [3,4]. The anatomic location of the heart in the mediastinal space may change after pneumonectomy, lobectomy, and segmentectomy because of lung tumors, infiltrative pulmonary diseases, chronic obstructive lung disease, emphysema, chronic pulmonary infections, and bronchiectasis [5][6][7].…”

“…However, there is no comprehensive study possible electrocardiography (ECG) changes after lung resection. A limited number of studies focused on the PR distance, QT distance, and QRS complex superficially as ECG changes in a limited number of resection types with fewer cases [3,8,9].…”