Hemodynamic responses to ECT in a patient with critical aortic stenosis
| Autor: | Daniel Wambold, Laura Levin, Adele C. Viguera, Charles A. Welch, L. J. Drop |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
medicine.medical_treatment
Neuroscience (miscellaneous) Blood Pressure behavioral disciplines and activities Sudden death Electroconvulsive therapy medicine Humans Renal Insufficiency Electroconvulsive Therapy Depressive Disorder business.industry Hemodynamics Aortic Valve Stenosis Middle Aged medicine.disease Esmolol Psychiatry and Mental health Stenosis Blood pressure Death Sudden Cardiac Anesthesia Female Hemodialysis business Complication Kidney disease medicine.drug |
| Zdroj: | The journal of ECT. 16(1) |
| ISSN: | 1095-0680 |
| Popis: | We present a case study of a 46-year-old woman with a psychotic depressive illness of 2 months' duration with the coexisting medical diagnoses of critical aortic stenosis, severe labile hypertension, renal failure necessitating hemodialysis of 7-years' duration, and systemic lupus. Because of unresponsiveness to an antidepressant drug regimen, severe motor retardation, mutism, and refusal of food and fluids by mouth, an urgent indication for electroconvulsive therapy (ECT) was established. However, the patient refused ECT, and to allow its initiation, a court order was obtained. In view of the coexisting diagnoses of critical aortic stenosis, labile hypertension, and renal failure, ECT represented a substantially increased risk in this patient because of severe arterial hypertension and tachycardia. The patient was successfully managed during each ECT, using a combination of metoprolol by mouth, which was supplemented by i.v. esmolol immediately prior to the application of the ECT stimulus, and sodium nitroprusside, which was infused for several minutes prior to the seizure and thereafter to attenuate arterial hypertension. Nevertheless, sudden death, a well-known complication of critical aortic stenosis, occurred 96 hours after the fourth ECT. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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