ECT After Recurrent MI
Out on PubMed is this LTE from clinicians in Singapore:Case Report of Electroconvulsive Therapy after Recurrent Myocardial Infarction.
Psychiatry Clin Neurosci. 2020 Aug 14. doi: 10.1111/pcn.13129. Online ahead of print.PMID: 32797651
This case describes a 51-year old female with a diagnosis of "catatonic schizophrenia" who apparently had two relatively minor myocardial infarctions ( a "low-risk non-ST elevation MI," and a "Type II MI") seven and four weeks before ECT. The cardiac events are not adequately described in terms of severity and functional cardiac status (although ejection fraction (EF) is reported at 65-70% after the first event). The patient recovered, with resolution of catatonia, with three bifrontal ECT. The details of intraprocedural vital signs are sparse; medication management was by additional p.o. beta blocker the night before ECT.
This case report adds very modestly to the literature about the safety of ECT in cardiac patients. It seems that patient had suffered two relatively minor myocardial infarctions, with little functional impairment and good recovery before ECT, although the report is not adequately detailed to know for sure.
More interesting than the cardiac aspects of the case report are the psychiatric-the patient had dramatic resolution of catatonia with 3 treatments. Also, from the case history, it sounds like the patient had an episodic course, raising the possibility that the diagnosis might more properly have been recurrent psychotic depression, although this is purely speculative, without additional history.
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