Bezold-Jarisch reflex in a patient undergoing endoscopic sympathectomy for management of refractory angina pectoris: a case report
Background and objectives: Ischemic cardiomyopathy is characterized by imbalance between supply and demand of myocardial oxygen. Endoscopic transthoracic sympathectomy is a therapeutic option indicated in refractory cases. However, the patient's position on the operating table may favor ischemi...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-01-01
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| Series: | Brazilian Journal of Anesthesiology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001415001621 |
| _version_ | 1797998307234021376 |
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| author | Wendell Jackson de Macêdo Caldas Maíra Ferreira Barbosa Cremilda Pinheiro Dias |
| author_facet | Wendell Jackson de Macêdo Caldas Maíra Ferreira Barbosa Cremilda Pinheiro Dias |
| author_sort | Wendell Jackson de Macêdo Caldas |
| collection | DOAJ |
| description | Background and objectives: Ischemic cardiomyopathy is characterized by imbalance between supply and demand of myocardial oxygen. Endoscopic transthoracic sympathectomy is a therapeutic option indicated in refractory cases. However, the patient's position on the operating table may favor ischemic coronary events triggering the Bezold-Jarisch reflex. Case report: A female patient, 47 years old, with refractory ischemic cardiomyopathy, admitted to the operating room for endoscopic transthoracic sympathectomy, developed the Bezold-Jarisch reflex with severe bradycardia and hypotension after placement in semi-sitting position to the procedure. Conclusion: Bradyarrhythmia, hypotension, and asystole are complications potentially associated with patient placement in a semi-sitting position, particularly in cases with previous ischemic heart disease. Resumo: Justificativa e objetivos: A cardiomiopatia isquêmica caracteriza-se pelo desbalanço entre a oferta e o consumo de oxigênio pelo miocárdio. A simpatectomia transtorácica endoscópica é uma opção terapêutica indicada nos casos refratários. Contudo, a posição do paciente na mesa cirúrgica pode favorecer eventos coronarianos isquêmicos e deflagrar o reflexo de Bezold-Jarisch. Relato de caso: Paciente do sexo feminino, 47 anos, portadora de cardiomiopatia isquêmica refratária, admitida na sala de cirurgia para simpatectomia transtorácica endoscópica, deflagrou o reflexo de Bezold-Jarisch e desenvolveu bradicardia e hipotensão graves logo após colocação em posição semissentada para o procedimento. Conclusão: Bradiarritmia, hipotensão e assistolia são complicações potencialmente associadas à colocação do paciente em posição semissentada, especialmente nos casos em que há prévio comprometimento isquêmico do coração. Keywords: Bezold-Jarisch reflex, Endoscopic transthoracic sympathectomy, Ischemic cardiomyopathy, Palavras-chave: Reflexo de Bezold-Jarisch, Simpatectomia transtorácica endoscópica, Cardiomiopatia isquêmica |
| first_indexed | 2024-04-11T10:46:37Z |
| format | Article |
| id | doaj.art-4b1dda4d0f3f48448d921c65b7d4930b |
| institution | Directory Open Access Journal |
| issn | 0104-0014 |
| language | English |
| last_indexed | 2024-04-11T10:46:37Z |
| publishDate | 2018-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj.art-4b1dda4d0f3f48448d921c65b7d4930b2022-12-22T04:29:01ZengElsevierBrazilian Journal of Anesthesiology0104-00142018-01-016819699Bezold-Jarisch reflex in a patient undergoing endoscopic sympathectomy for management of refractory angina pectoris: a case reportWendell Jackson de Macêdo Caldas0Maíra Ferreira Barbosa1Cremilda Pinheiro Dias2Hospital Universitário Getúlio Vargas, CET Integrado do Instituto de Anestesiologia do Amazonas, Manaus, AM, Brazil; Corresponding author.Hospital Universitário Getúlio Vargas, CET Integrado do Instituto de Anestesiologia do Amazonas, Manaus, AM, Brazil; Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, BrazilHospital Universitário Getúlio Vargas, CET Integrado do Instituto de Anestesiologia do Amazonas, Manaus, AM, BrazilBackground and objectives: Ischemic cardiomyopathy is characterized by imbalance between supply and demand of myocardial oxygen. Endoscopic transthoracic sympathectomy is a therapeutic option indicated in refractory cases. However, the patient's position on the operating table may favor ischemic coronary events triggering the Bezold-Jarisch reflex. Case report: A female patient, 47 years old, with refractory ischemic cardiomyopathy, admitted to the operating room for endoscopic transthoracic sympathectomy, developed the Bezold-Jarisch reflex with severe bradycardia and hypotension after placement in semi-sitting position to the procedure. Conclusion: Bradyarrhythmia, hypotension, and asystole are complications potentially associated with patient placement in a semi-sitting position, particularly in cases with previous ischemic heart disease. Resumo: Justificativa e objetivos: A cardiomiopatia isquêmica caracteriza-se pelo desbalanço entre a oferta e o consumo de oxigênio pelo miocárdio. A simpatectomia transtorácica endoscópica é uma opção terapêutica indicada nos casos refratários. Contudo, a posição do paciente na mesa cirúrgica pode favorecer eventos coronarianos isquêmicos e deflagrar o reflexo de Bezold-Jarisch. Relato de caso: Paciente do sexo feminino, 47 anos, portadora de cardiomiopatia isquêmica refratária, admitida na sala de cirurgia para simpatectomia transtorácica endoscópica, deflagrou o reflexo de Bezold-Jarisch e desenvolveu bradicardia e hipotensão graves logo após colocação em posição semissentada para o procedimento. Conclusão: Bradiarritmia, hipotensão e assistolia são complicações potencialmente associadas à colocação do paciente em posição semissentada, especialmente nos casos em que há prévio comprometimento isquêmico do coração. Keywords: Bezold-Jarisch reflex, Endoscopic transthoracic sympathectomy, Ischemic cardiomyopathy, Palavras-chave: Reflexo de Bezold-Jarisch, Simpatectomia transtorácica endoscópica, Cardiomiopatia isquêmicahttp://www.sciencedirect.com/science/article/pii/S0104001415001621 |
| spellingShingle | Wendell Jackson de Macêdo Caldas Maíra Ferreira Barbosa Cremilda Pinheiro Dias Bezold-Jarisch reflex in a patient undergoing endoscopic sympathectomy for management of refractory angina pectoris: a case report Brazilian Journal of Anesthesiology |
| title | Bezold-Jarisch reflex in a patient undergoing endoscopic sympathectomy for management of refractory angina pectoris: a case report |
| title_full | Bezold-Jarisch reflex in a patient undergoing endoscopic sympathectomy for management of refractory angina pectoris: a case report |
| title_fullStr | Bezold-Jarisch reflex in a patient undergoing endoscopic sympathectomy for management of refractory angina pectoris: a case report |
| title_full_unstemmed | Bezold-Jarisch reflex in a patient undergoing endoscopic sympathectomy for management of refractory angina pectoris: a case report |
| title_short | Bezold-Jarisch reflex in a patient undergoing endoscopic sympathectomy for management of refractory angina pectoris: a case report |
| title_sort | bezold jarisch reflex in a patient undergoing endoscopic sympathectomy for management of refractory angina pectoris a case report |
| url | http://www.sciencedirect.com/science/article/pii/S0104001415001621 |
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