Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Recurrent ST segment elevations in a patient with asymptomatic early repolarization during head and neck surgery: implications of vasospastic angina

  • Park, Se-Ung (Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine) ;
  • Kim, Sung-Hoon (Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine) ;
  • Kwon, Hye-Mee (Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine) ;
  • Koh, Gi-Ho (Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine) ;
  • Nam, Gi-Byoung (Department of Cardiology, University of Ulsan College of Medicine) ;
  • Karm, Myong-Hwan (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Kim, Wook-Jong (Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine) ;
  • Ku, Seung-Woo (Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine)
  • Received : 2018.05.19
  • Accepted : 2018.06.13
  • Published : 2018.06.30
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Abstract

A 57-year-old woman scheduled for cochlear implant removal exhibited preoperative electrocardiographic findings of early repolarization (ER). Four episodes of transient ST segment elevations during surgery raised suspicion for vasospastic angina (VA). In the post-anesthetic care unit, the patient complained of chest discomfort and received sublingual nitroglycerin with uncertain effect. The patient refused to proceed with postoperative invasive coronary angiography, resulting in inconclusive diagnosis. Intraoperative circumstances limit the diagnosis of VA, which emphasizes the need for further testing to confirm the diagnosis. When VA is suspected in patients with underlying ER, it is reasonable to consider invasive examination to establish the diagnosis and prevent recurrence of VA. If ST changes are observed during surgery in patients with preoperative ER, careful monitoring is recommended. Due to general anesthesia, the absence of patient symptoms limits the definitive diagnosis of those with suspected VA. Therefore, additional postoperative surveillance is recommended.

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References

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