Recurrent intraoperative silent ST depression responding to phenylephrine

Abstract

Intraoperative myocardial ischemia is attributed to decreased myocardial oxygen supply. We present an unusual case of recurrent, symptomless inferior wall ischemia in an apparently healthy male with no history of coronary artery disease after a spinal block. The recurring episodes were linked to tachycardia and presented with significant ST depression in Lead II with reciprocal elevation in lead aVL. The episodes responded to phenylephrine and subsided without residual sequelae.

Non Specific S-T Segment Variations during Intravenous Induction in Anesthesia in Hypertensive Patients Treated with Renin Angiotensin System Antagonists

“…With a careful analysis of the degree of ST depression and the character and depth of inversion of the T waves, were found correlations between these findings with developed hypotension (>30 mmHg) in the Group A. There are several reports about the interaction of hypotension in patients who received angiotensin-converting enzyme inhibitors (ACEIs) before a surgical procedure, suggesting that interactions between ACEIs and anesthesia may be neither beneficial nor predictable [23][24][25][26][27]. The answer of such hypotension is hidden in the pharmacology of the antagonist of RAS.…”

Post-operative severe hypokalemia mimicking myocardial ischemia

“…Perioperative ST segment depression with tachycardia is often attributed to be of ischemic origin. [ 1 ] It becomes all the more important in patients with diabetes and hypertension where patients stand higher risks of coronary diseases and silent ischemic events. Although, a high index of suspicion should be maintained for ischemia, but the possibility of alternative diagnosis should not be negated without appropriate investigation.…”