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The query corner
The Query Corner R
EADERS are
invited to submit queries on all aspects of cardiovascular
far as possible these will be answered in this column by competent
diseases.
authorities.
InsoThe
replies will not necessarily represent the opinions of the American
College of Cardiology,
the JOURNAL or any medical organization or group, unless stated.
Anonymous
cations and queries on postcards will not be answered.
communi-
Every letter must contain the writ-
er’s name and address, but these will not be published.
Cardiovascular Complications Following Electroshock Therapy Query: involved heart
Please
discuss
in evaluating
disease
who rep&es
some of the clinical
and
treating electrical
jrohlems
the patient shock
Atria1 Fibrillation: Two women with mitral stenosis, both under thirty years and one woman aged sixty years with arteriosclerotic heart disease died after treatment in the course of atria1 fibrillation with well controlled ventricular rates in the absence of congestive heart failure. Subacute Bacterial Endocarditis: In a young woman with an unsuspected streptoccocus viridans infection of the mitral valve, numerous emboli to the brain developed following treatment and she died as a result of these. Thrombosis of the Carotid Artery: In a fifty-four year old woman, coma developed immediately after treatment. Operative intervention on the brain revealed the presence of a fresh thrombus involving the whole of the right carotid artery. Persistent Conuulsions: In one patient with antecedent cerebrovascular accidents and in another with diffuse disease of the arteries of the brain, electroshock therapy resulted in persistent convulsions lasting twenty-four and sixty-two hours, respectively, and ending in death. Conclusions: The intimate factors responsible for precipitating death in these patients are still unknown. It would be best to avoid electroshock therapy in patients with angina pectoris, recent infarction of the heart, subacute bacterial endocarditis or in those in whom cerebrovascular accidents would be liable to yield convulsions.
with
therafiy.
Answer: These observations summarize our experiences with fatal cardiovascular accidents observed to have followed approximately lOO,000 electroconvulsive treatments to 17,000 patients over a period of twelve years at the West Hill Sanitarium. The more recent use of atropine to avoid extravagal factors and the intravenous use of barbiturates and succinylcholine (Anectine@) chloride intravenously as well as ventilation with 100 per cent oxygen during the apneic phases of treatment, have in no way prevented fatal cardiovascular accidents. It has been found impossible to avoid such fatalities with the best means at our disposal. Angina Pectoris: One woman with angina pectoris died immediately following treatment. Infarction of the heart developed in six patients. Infarction of the Heart: There were fourteen deaths that could be attributed to this condition. In nine, death occurred immediately after treatment and in five, within the first twenty-four hours after therapy. The ages of the patients ranged between forty-two and sixty-four years. None had any symptoms except electrocardiographic changes of healed infarcts of at least four months’ duration. Confirmation at autopsy revealed healed infarcts in five and fresh thrombi of the coronary arteries in two.
SIDNEY
P. SCHWARTZ,
BERNARD
PACELLA,
M.D. M.D.
New York, New York
288
THE AMERICAN JOURNAL OF CARDIOLOGY
EADERS are
invited to submit queries on all aspects of cardiovascular
far as possible these will be answered in this column by competent
diseases.
authorities.
InsoThe
replies will not necessarily represent the opinions of the American
College of Cardiology,
the JOURNAL or any medical organization or group, unless stated.
Anonymous
cations and queries on postcards will not be answered.
communi-
Every letter must contain the writ-
er’s name and address, but these will not be published.
Cardiovascular Complications Following Electroshock Therapy Query: involved heart
Please
discuss
in evaluating
disease
who rep&es
some of the clinical
and
treating electrical
jrohlems
the patient shock
Atria1 Fibrillation: Two women with mitral stenosis, both under thirty years and one woman aged sixty years with arteriosclerotic heart disease died after treatment in the course of atria1 fibrillation with well controlled ventricular rates in the absence of congestive heart failure. Subacute Bacterial Endocarditis: In a young woman with an unsuspected streptoccocus viridans infection of the mitral valve, numerous emboli to the brain developed following treatment and she died as a result of these. Thrombosis of the Carotid Artery: In a fifty-four year old woman, coma developed immediately after treatment. Operative intervention on the brain revealed the presence of a fresh thrombus involving the whole of the right carotid artery. Persistent Conuulsions: In one patient with antecedent cerebrovascular accidents and in another with diffuse disease of the arteries of the brain, electroshock therapy resulted in persistent convulsions lasting twenty-four and sixty-two hours, respectively, and ending in death. Conclusions: The intimate factors responsible for precipitating death in these patients are still unknown. It would be best to avoid electroshock therapy in patients with angina pectoris, recent infarction of the heart, subacute bacterial endocarditis or in those in whom cerebrovascular accidents would be liable to yield convulsions.
with
therafiy.
Answer: These observations summarize our experiences with fatal cardiovascular accidents observed to have followed approximately lOO,000 electroconvulsive treatments to 17,000 patients over a period of twelve years at the West Hill Sanitarium. The more recent use of atropine to avoid extravagal factors and the intravenous use of barbiturates and succinylcholine (Anectine@) chloride intravenously as well as ventilation with 100 per cent oxygen during the apneic phases of treatment, have in no way prevented fatal cardiovascular accidents. It has been found impossible to avoid such fatalities with the best means at our disposal. Angina Pectoris: One woman with angina pectoris died immediately following treatment. Infarction of the heart developed in six patients. Infarction of the Heart: There were fourteen deaths that could be attributed to this condition. In nine, death occurred immediately after treatment and in five, within the first twenty-four hours after therapy. The ages of the patients ranged between forty-two and sixty-four years. None had any symptoms except electrocardiographic changes of healed infarcts of at least four months’ duration. Confirmation at autopsy revealed healed infarcts in five and fresh thrombi of the coronary arteries in two.
SIDNEY
P. SCHWARTZ,
BERNARD
PACELLA,
M.D. M.D.
New York, New York
288
THE AMERICAN JOURNAL OF CARDIOLOGY