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Pronounced unexplained preoperative tachycardia heralding serious cardiac events: a series of three cases

Tachycardie préopératoire prononcée, inexpliquée, prodrome ďévénements cardiaques sérieux : une série de trois cas

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Abstract

Purpose

Pronounced, unexplained preoperative tachycardia can be a formidable challenge for the anesthesiologist. Whereas the relationship between persistent intraoperative tachycardia and perioperative morbidity is indisputable, there is a lack of available data on unexplained preoperative tachycardia. The main objective of this case series is to stimulate research and discussion on this topic, so that guidelines can be developed to aid in management.

Clinical features

We present three patients with pronounced ≥ 130 beats·min-1 unexplained preoperative tachycardia who suffered adverse perioperative events that were garnered from quality improvement records at two teaching hospitals. In the first case, a 38-yr-old woman with a lumbar spinal tumour went into ventricular fibrillation after induction of anesthesia and was found on subsequent evaluation to have an abnormal cardiac re-entrant pathway. In the second case, an otherwise healthy middle-aged man developed a wide complex tachycardia with hypotension during foot surgery, with the subsequent cardiac evaluation being negative. In the third case, a young, healthy woman scheduled for a melanoma incision developed crushing, substernal chest pain accompanied by nausea and shortness of breath prior to incision. An echocardiogram revealed mitral valve prolapse with regurgitation. Before rescheduling the procedures, therapeutic interventions were undertaken that facilitated successful completion of the surgeries.

Conclusions

There are currently no data regarding the prevalence of unexplained preoperative tachycardia, and no guidelines to direct management. More research is needed on this important topic, including epidemiological data and management algorithm(s).

Résumé

Objectif

Une tachycardie préopératoire prononcée et inexpliquée peut être tout un défi pour ľanesthésiologiste. La relation entre la tachycardie peropératoire persistante et la morbidité périopératoire est incontestable, mais les données sont incomplètes pour expliquer la tachycardie préopératoire. Ľobjectif principal de la série de cas est de stimuler la recherche et la discussion sur le sujet de sorte que des lignes directrices soient élaborées pour guider la conduite à tenir.

Éléments cliniques

Nous présentons trois patients atteints de tachycardie préopératoire prononcée (≥ 130 battements·min-1) et inexpliquée qui ont souffert de réactions indésirables documentées dans les dossiers ďamélioration de la qualité de deux hôpitaux universitaires. Dans le premier cas, on a observé une fibrillation ventriculaire après ľinduction de ľanesthésie et un mécanisme réentrant anormal, lors ďune évaluation ultérieure, chez une femme de 38 ans atteinte ďune tumeur de la moelle lombaire. Dans le second cas, une tachycardie à larges complexes s’est développée avec de ľhypotension pendant une opération du pied chez un homme ďâge moyen, par ailleurs en bonne santé. ľévaluation cardiaque ultérieure s’est révélée négative. Dans le troisiéme cas, une jeune femme en santé, devant être opérée pour un mélanome, a souffert de douleurs thoraciques rétrosternales constrictives, accompagnées de nausées et ďessoufflement, avant ľincision. Un échocardiogramme a révélé un prolapsus valvulaire mitral avec régurgitation. Avant de replanifier les opérations, des interventions thérapeutiques ont été entreprises pour faciliter ľexécution réussie de ľintervention chirurgicale.

Conclusion

Actuellement, il n’y a pas de données sur la prévalence de tachycardie préopératoire inexpliquée et pas de normes de prise en charge directe du probléme. Il faut ďautres recherches, y compris sur les données épidémiologiques et les algorithmes décisionnels.

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Correspondence to Steven P. Cohen or Christopher Kent.

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Cohen, S.P., Kent, C. Pronounced unexplained preoperative tachycardia heralding serious cardiac events: a series of three cases. Can J Anesth 52, 858 (2005). https://doi.org/10.1007/BF03021782

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