The management and outcome of documented intraoperative heart rate-related electrocardiographic changes

J Cardiothorac Vasc Anesth. 2011 Oct;25(5):791-8. doi: 10.1053/j.jvca.2011.03.174. Epub 2011 Jul 2.


Objectives: The authors analyzed surgical cases in which electrocardiographic (ECG) signs of cardiac ischemia were noted to be precipitated by increases in heart rate (ie, heart rate-related ECG changes [REC]). The authors aimed to find REC incidence, specificity for coronary artery disease (CAD), and the outcome associated with different management strategies.

Design: A retrospective review.

Setting: A university hospital, tertiary care.

Participants: Patients undergoing surgery under anesthesia.

Interventions: A chart review.

Measurements: The authors searched 158,252 anesthesia electronic records for comments noting REC (ie, ST-segment or T-wave changes). After excluding cases with potentially confounding conditions (eg, hypotension, hyperkalemia, and so on), 26 cases were analyzed.

Results: REC commonly was precipitated by anesthesia-related events (ie, intubation, extubation, and treatment of bradycardia). In 24 cases, REC was managed by prompt heart rate reduction using β-blocker agents, opioids, and/or cardioversion in the addition to the removal of stimulus. Only 1 case had a copy of the ECG printed. Two cases were aborted, 1 was shortened and 23 proceeded without change. Postoperative troponin T levels were checked, and cardiology consultation was obtained in selected cases and led to further cardiac evaluation in 6 cases. Postoperative myocardial infarction developed in only 1 patient in whom the ECG changes were allowed to persist throughout the case.

Conclusions: This incidence of reported REC was much lower than the previously reported incidence of ischemia-related ECG changes, suggesting that the largest proportion of events go unnoticed. In many patients, subsequent cardiology workup did not confirm the existence of clinically significant CAD.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adrenergic beta-Antagonists / therapeutic use
  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthesia
  • Blood Pressure / physiology
  • Bradycardia / complications
  • Bradycardia / therapy
  • Electrocardiography*
  • Exercise Test
  • Female
  • Follow-Up Studies
  • Heart Rate / physiology*
  • Humans
  • Hypotension / complications
  • Hypotension / therapy
  • Intraoperative Complications / epidemiology
  • Intraoperative Complications / mortality
  • Intraoperative Complications / therapy*
  • Male
  • Middle Aged
  • Monitoring, Intraoperative
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy
  • Postoperative Complications / therapy
  • Retrospective Studies
  • Surgical Procedures, Operative / methods
  • Treatment Outcome


  • Adrenergic beta-Antagonists