Use of Electroconvulsive Therapy in a Patient 10 Days After Myocardial Infarction

Abstract

Electroconvulsive therapy (ECT) is a safe and effective treatment of severe depression, even in patients with cardiac risk factors. Although rare, cardiovascular events during ECT remain a principal cause of morbidity and mortality. In particular, a history of recent myocardial infarction (MI) increases the risk of ventricular arrhythmias and cardiac rupture. A widely accepted recommendation is to administer ECT at least 3 months after MI, but sometimes a delay is not possible. Limited literature exists on the use of ECT in severely depressed patients with recent MI. Our literature review revealed 1 previously published case, with less than favorable results. In this case report, we describe a severely depressed, catatonic elderly man who was safely and successfully treated with ECT 10 days after an acute MI. It is essential that appropriate cardiac management be provided before, during, and after ECT by a multidisciplinary team of psychiatrists, internists, cardiologists, and anesthesiologists. Our case report suggests that, with proper management and close monitoring, ECT can be administered safely, even in patients with recent MI.

Electroconvulsive Therapy in Child and Adolescent Psychiatry

“…Cardiovascular conditions such as congestive heart failure, unstable angina, valvular disease, arrhythmias, aneurysms, recent myocardial infarctions can significantly increase a patient's risk during ECT. Although, there are no definitive studies on safety after a myocardial infarction, ECT has been successfully administered to an adult patient with a recent (within10 days) myocardial infarction [55] and another adult patient with dilated cardiomyopathy who was awaiting a heart transplant [56]. With proper precautions, ECT may be a safe modality for patients with severe depression and cardiac disease [57].…”

Treatment of depression in patients with congestive heart failure

“…Case reports and clinical series have described successful ECT in patients shortly after acute myocardial infarction, in patients with impaired left ventricular function and cardiac conduction abnormalities, and in series of miscellaneous ''high cardiac risk'' patients [40][41][42][43][44]. Specific pharmacological management, to avoid both asystole and severe hypertension and tachycardia that may result in myocardial ischemic injury, must be adjusted for the individual patient.…”

Anesthesia Management of Special Patient Populations Undergoing Electroconvulsive Therapy: A Review

“…Accordingly, a thorough cardiac evaluation is considered to be mandatory prior to the use of ECT 7,26 . Generally, the guidelines given by the American College of Cardiology/American Heart Association for non-cardiac procedures requiring general anesthesia are also followed for ECT 27,28 , and these guidelines suggest that acute MI within one week or severe MI within the last four weeks is associated with an increase in perioperative morbidity. Therefore, it is recommended to wait for 4-6 weeks after MI to perform elective procedures.…”