Assessment of the cardiovascular effects of electroconvulsive therapy in individuals older than 50 years

To evaluate the impact of electroconvulsive therapy on arterial blood pressure, heart rate, heart rate variability, and the occurrence of ischemia or arrhythmias, 38 (18 men) depressive patients free from systemic diseases, 50 to 83 years old (mean: 64.7 ± 8.6) underwent electroconvulsive therapy. All patients were studied with simultaneous 24-h ambulatory blood pressure and Holter monitoring, starting 18 h before and continuing for 3 h after electroconvulsive therapy. Blood pressure, heart rate, heart rate variability, arrhythmias, and ischemic episodes were recorded. Before each session of electroconvulsive therapy, blood pressure and heart rate were in the normal range; supraventricular ectopic beats occurred in all patients and ventricular ectopic beats in 27/38; 2 patients had non-sustained ventricular tachycardia. After shock, systolic, mean and diastolic blood pressure increased 29, 25, and 24 percent (P < 0.001), respectively, and returned to baseline values within 1 h. Maximum, mean and minimum heart rate increased 56, 52, and 49 percent (P < 0.001), respectively, followed by a significant decrease within 5 min; heart rate gradually increased again thereafter and remained elevated for 1 h. Analysis of heart rate variability showed increased sympathetic activity during shock with a decrease in both sympathetic and parasympathetic drive afterwards. No serious adverse effects occurred; electroconvulsive therapy did not trigger any malignant arrhythmias or ischemia. In middle-aged and elderly people free from systemic diseases, electroconvulsive therapy caused transitory increases in blood pressure and heart rate and a decrease in heart rate variability but these changes were not associated with serious adverse clinical events.

Beneficial effect of long-term use of a beta-blocker in patients before acute myocardial infarction

The outcome of 38 beta-blocker users (group BB, 28 men and 10 women with a mean age of 56 ñ 4 years) was compared to that of 100 non-users (group NU, 69 men and 31 women with mean age of 57 ñ 8 years) after acute myocardial infarction (AMI). The two groups were compared in terms of electrocardiographic (EKG) location of the AMI (anterior, inferior and lateral), EKG Q and non-Q wave infarction, clincial functional class of Forrester, serum cratine phosphokinase MB fraction (CKMB) peak release and intrahospital mortality.There were no differences between groups concerning sex or severity of coronary artery disease bath arterial hypertension was 3-fold more prevalent group BB. The EKG location of the AMI was similar int he two groups. Non-Q infarction was significantly more prevalent in group BB (37 percent) than in group NU (5 percent). The incidence of clinical functional class IV of Forrester and the serum CKMB peaks were significantly lower in goup BB (2.6 percent vs 16.0 percent and 53 ñ 3 vs 68 ñ 9 UI/1, respectively. Intrahospital mortality was also significantly lower in group BB (2.6 percent) than in group NU (10 percent). These data suggest the beneficial effect of previous long-term use of beta-blockers as indicated by a lower incidence of cardiogenic shock and a significant decrease in intrahospital mortality after AMI

Estudo das extrassistoles ventriculares na fase hospitalar do infarto do miocardio. / Ventricular extrasystoles in the hospital phase of myocardial infarction

A incidencia e o significado clinico das extrassistoles ventriculares (EV) na fase hospitalar do infarto agudo do miocardio (IAM) foram estudados em 43 pacientes admitidos no hospital, sete horas, em media, apos o inicio do quadro doloroso precordial; 21 tinham infarto de parede anterior (IMA) e 22, infarto de parede inferior (IMI). Os pacientes foram submetidos a monitorizacao eletrocardiografica pelo sistema Holter, durante 24 horas, na admissao hospitalar (H1) e nos terceiro (H2), sexto (H3), 12o. (H4) e 18o. (H5) dias de evolucao hospitalar; em H1, houve alguma EV em 95,3% dos pacientes (90,5% dos IMA e 100% dos IMI) e em H5, em 73% deles (58,8% dos IMA e 85% dos IMI). Por outro lado, de H2 a H5, a maioria dos pacientes nao se distinguiu da populacao em geral, quanto a frequencia de EV em 24 horas. Houve predominio significativa entre os resultados de H1 e H2. As EV nao se relacionaram a localizacao eletrocardiografica do infarto, a fracao de ejecao e ao numero de arterias coronarias lesadas, tanto na fase aguda (H1) como na fase tardia hospitalar (H5)