Postoperative electrocardiography changes: To worry or not to worry
Abstract Abnormal postoperative electrocardiograms are not uncommon, oftentimes leading to further cardiac workup especially when the findings are new and not easily explainable. A forty‐year‐old woman, with a history of left breast cancer status post bilateral mastectomies and reconstructions, pres...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-01-01
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| Series: | Annals of Noninvasive Electrocardiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/anec.13092 |
| _version_ | 1797338739942359040 |
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| author | Chihjen Lee Janet Shin Arash Bereliani Liza Capiendo Eiman Firoozmand Roya Yumul |
| author_facet | Chihjen Lee Janet Shin Arash Bereliani Liza Capiendo Eiman Firoozmand Roya Yumul |
| author_sort | Chihjen Lee |
| collection | DOAJ |
| description | Abstract Abnormal postoperative electrocardiograms are not uncommon, oftentimes leading to further cardiac workup especially when the findings are new and not easily explainable. A forty‐year‐old woman, with a history of left breast cancer status post bilateral mastectomies and reconstructions, presented for robot‐assisted low‐anterior resection secondary to rectal cancer. Postoperative electrocardiogram showed poor R wave progression, biphasic T waves in V2‐4, and possible anterior wall ischemia. Her electrocardiogram from 6 years ago was normal. No recent electrocardiogram was available for comparison. Initially, the abnormal postoperative electrocardiogram appeared worrisome. However, the patient was completely asymptomatic, and all vital signs were normal. Cardiac point‐of‐care ultrasound showed normal parasternal long and short axis views. The biphasic T waves in V2‐4 were suggestive of Wellens syndrome, but the accompanying poor R wave progression was not consistent with the diagnostic criteria. The anesthesiologist then remembered the patient's history of the presence of a left breast implant and suspected it might have caused the changes on the electrocardiogram. A literature search did find one publication that shows approximately 45% of patients with breast implants present with electrocardiogram changes, including poor R wave progression and negative T waves. Therefore, no further cardiac workup was ordered for our patient. She was discharged home 3 days later. Breast implants and electrocardiogram changes are a lesser‐known topic. Obtaining a pre‐operative electrocardiogram should be considered in patients with previous breast implants, to serve as a baseline for comparison if the patient were to need another electrocardiogram in the future. |
| first_indexed | 2024-03-08T09:35:39Z |
| format | Article |
| id | doaj.art-43cd27395ae7449e99be089411332560 |
| institution | Directory Open Access Journal |
| issn | 1082-720X 1542-474X |
| language | English |
| last_indexed | 2024-03-08T09:35:39Z |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Noninvasive Electrocardiology |
| spelling | doaj.art-43cd27395ae7449e99be0894113325602024-01-30T08:36:49ZengWileyAnnals of Noninvasive Electrocardiology1082-720X1542-474X2024-01-01291n/an/a10.1111/anec.13092Postoperative electrocardiography changes: To worry or not to worryChihjen Lee0Janet Shin1Arash Bereliani2Liza Capiendo3Eiman Firoozmand4Roya Yumul5Department of Anesthesiology Cedars‐Sinai Medical Center Los Angeles CA USADepartment of Anesthesiology Cedars‐Sinai Medical Center Los Angeles CA USADepartment of Cardiology Cedars‐Sinai Medical Center Los Angeles CA USADepartment of Surgery Cedars‐Sinai Medical Center Los Angeles CA USADepartment of Surgery Cedars‐Sinai Medical Center Los Angeles CA USADepartment of Anesthesiology Cedars‐Sinai Medical Center Los Angeles CA USAAbstract Abnormal postoperative electrocardiograms are not uncommon, oftentimes leading to further cardiac workup especially when the findings are new and not easily explainable. A forty‐year‐old woman, with a history of left breast cancer status post bilateral mastectomies and reconstructions, presented for robot‐assisted low‐anterior resection secondary to rectal cancer. Postoperative electrocardiogram showed poor R wave progression, biphasic T waves in V2‐4, and possible anterior wall ischemia. Her electrocardiogram from 6 years ago was normal. No recent electrocardiogram was available for comparison. Initially, the abnormal postoperative electrocardiogram appeared worrisome. However, the patient was completely asymptomatic, and all vital signs were normal. Cardiac point‐of‐care ultrasound showed normal parasternal long and short axis views. The biphasic T waves in V2‐4 were suggestive of Wellens syndrome, but the accompanying poor R wave progression was not consistent with the diagnostic criteria. The anesthesiologist then remembered the patient's history of the presence of a left breast implant and suspected it might have caused the changes on the electrocardiogram. A literature search did find one publication that shows approximately 45% of patients with breast implants present with electrocardiogram changes, including poor R wave progression and negative T waves. Therefore, no further cardiac workup was ordered for our patient. She was discharged home 3 days later. Breast implants and electrocardiogram changes are a lesser‐known topic. Obtaining a pre‐operative electrocardiogram should be considered in patients with previous breast implants, to serve as a baseline for comparison if the patient were to need another electrocardiogram in the future.https://doi.org/10.1111/anec.13092biphasic T wavesbreast implantsfluorouracilpoint‐of‐care ultrasoundpoor R‐wave progressionprecordial lead placements |
| spellingShingle | Chihjen Lee Janet Shin Arash Bereliani Liza Capiendo Eiman Firoozmand Roya Yumul Postoperative electrocardiography changes: To worry or not to worry Annals of Noninvasive Electrocardiology biphasic T waves breast implants fluorouracil point‐of‐care ultrasound poor R‐wave progression precordial lead placements |
| title | Postoperative electrocardiography changes: To worry or not to worry |
| title_full | Postoperative electrocardiography changes: To worry or not to worry |
| title_fullStr | Postoperative electrocardiography changes: To worry or not to worry |
| title_full_unstemmed | Postoperative electrocardiography changes: To worry or not to worry |
| title_short | Postoperative electrocardiography changes: To worry or not to worry |
| title_sort | postoperative electrocardiography changes to worry or not to worry |
| topic | biphasic T waves breast implants fluorouracil point‐of‐care ultrasound poor R‐wave progression precordial lead placements |
| url | https://doi.org/10.1111/anec.13092 |
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