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Cardiovascular risk during ECT: managing the managers. ECT期间的心血管风险:管理管理者。
Convulsive therapy Pub Date : 1997-09-01
W V McCall
{"title":"Cardiovascular risk during ECT: managing the managers.","authors":"W V McCall","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 3","pages":"123-4"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20274831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Safe administration of ECT in a patient with a cardiac aneurysm and multiple cardiac risk factors. 有心脏动脉瘤和多种心脏危险因素的病人电痉挛疗法的安全应用。
Convulsive therapy Pub Date : 1997-09-01
M W Gardner, C H Kellner, D E Hood, G H Hendrix
{"title":"Safe administration of ECT in a patient with a cardiac aneurysm and multiple cardiac risk factors.","authors":"M W Gardner,&nbsp;C H Kellner,&nbsp;D E Hood,&nbsp;G H Hendrix","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 41-year-old man with a left ventricular aneurysm received electroconvulsive therapy (ECT) for treatment of depression, tolerating the procedure without any cardiovascular complications. This case suggests that ECT may be safely administered to patients with ventricular aneurysm and multiple cardiac risk factors provided that additional precautions are taken.</p>","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 3","pages":"200-3"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20274733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The mortality rate with ECT. 电痉挛疗法的死亡率
Convulsive therapy Pub Date : 1997-09-01
R Abrams
{"title":"The mortality rate with ECT.","authors":"R Abrams","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>ECT is a low-risk procedure, even in the older cardiac patient who is fast becoming the modal candidate for this therapy. To put the mortal risk with ECT in proper perspective, it is only necessary to note that ECT is about 10 times safer than childbirth, that approximately 6 times as many deaths annually in the U.S. are caused by lightning as by ECT, that two complications of psychotropic drug therapy in younger women-fatal myocardial infarction and fatal subarachnoid hemorrhage-virtually never occur with ECT, and that the death rate reported for ECT is an order of magnitude smaller than the spontaneous death rate in the general population.</p>","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 3","pages":"125-7"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20274832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diagnosis and management of ischemic heart disease in the patient scheduled to undergo electroconvulsive therapy. 计划接受电休克治疗的缺血性心脏病患者的诊断和治疗。
Convulsive therapy Pub Date : 1997-09-01
R J Applegate
{"title":"Diagnosis and management of ischemic heart disease in the patient scheduled to undergo electroconvulsive therapy.","authors":"R J Applegate","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The cardiovascular risk of electroconvulsive therapy (ECT) is a product of the stress of ECT itself and the severity and stability of coronary artery disease (CAD), as well as other cardiovascular factors. ECT itself represents a relatively low-risk procedure. Patient-specific risk can be defined by a combination of clinical evaluation and noninvasive testing, much of which is aimed at detecting the presence and staging the severity and stability of CAD. Patients at high risk of a cardiac complication include those with severe or unstable symptoms of CAD, and they should undergo extensive cardiac evaluation before ECT Patients at low risk likely need no further evaluation and can undergo ECT. Patients at intermediate risk should have careful clinical evaluation, and most likely noninvasive evaluation, which should include some form of stress testing. Medical therapy should be continued and/or maximized in all patients with CAD. It is expected that with careful screening, patients with established CAD can undergo ECT safely.</p>","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 3","pages":"128-44"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20274833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Electroconvulsive therapy in patients with heart failure or valvular heart disease. 心力衰竭或瓣膜性心脏病患者的电休克治疗。
Convulsive therapy Pub Date : 1997-09-01
B K Rayburn
{"title":"Electroconvulsive therapy in patients with heart failure or valvular heart disease.","authors":"B K Rayburn","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>As the use of electroconvulsive therapy (ECT) increases, the chance of a practitioner's encountering a patient with significant heart failure, ventricular dysfunction, or valvular heart disease also increases. This article reviews the epidemiology, pathophysiology, and available data on the risk of ECT in these patients. Recommendations are made regarding evaluation and treatment of such patients. Some special situations are identified that may require a modification of routine procedures. Overall, ECT can be performed safely in most patients with underlying cardiac conditions, as long as appropriate precautions are taken to identify these patients ahead of time.</p>","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 3","pages":"145-56"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20274834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of esmolol pretreatment on EEG seizure morphology in RUL ECT. 艾司洛尔预处理对颅脑电痉挛发作形态学的影响。
Convulsive therapy Pub Date : 1997-09-01
W V McCall, D Zvara, R Brooker, L Arias
{"title":"Effect of esmolol pretreatment on EEG seizure morphology in RUL ECT.","authors":"W V McCall,&nbsp;D Zvara,&nbsp;R Brooker,&nbsp;L Arias","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Intravenous beta-blockers are an effective means of controlling heart rate and blood pressure during electroconvulsive therapy (ECT), but have been shown to decrease seizure duration. While the importance of seizure duration to the antidepressant response of ECT grows less certain, there is growing evidence that seizure morphology predicts the antidepressant effect of ECT. This study examined the impact of esmolol pretreatment on seizure morphology. Eighteen depressed patients (6 men, 12 women; 69 +/- 12.8 years old) received ECT with and without esmolol pretreatment in a randomized, blinded crossover design. The seizures were blindly rated for duration of motor convulsion, duration of electroencephalogram (EEG) seizure, degree of seizure regularity, and degree of postictal EEG suppression. Esmolol shortened the duration of the motor convulsion and degraded the quality of the ictal regularity. Routine administration of intravenous esmolol before ECT may cause a decrease in ictal regularity. Careful consideration should be given to the potential benefits of esmolol versus the deleterious effect on the electrophysiologic process. Esmolol may still be indicated on a case-by-case basis for extreme tachycardia or hypertension associated with ECT, and presumably poses no problem for the therapeutic effect of ECT if given after the seizure is over.</p>","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 3","pages":"175-80"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20274730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Anesthetic considerations of cardiovascular risk during electroconvulsive therapy. 电休克治疗期间心血管风险的麻醉考虑。
Convulsive therapy Pub Date : 1997-09-01
S Y Dolinski, D A Zvara
{"title":"Anesthetic considerations of cardiovascular risk during electroconvulsive therapy.","authors":"S Y Dolinski,&nbsp;D A Zvara","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This article focuses on anesthetic considerations of cardiovascular risk for electroconvulsive (ECT) therapy. Preoperative evaluation, intraoperative management, and postoperative care are reviewed. Although the anesthetic risk to ECT patients is quite low, elderly patients or those presenting with known cardiovascular disease may be at increased risk and need special intervention or management during ECT.</p>","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 3","pages":"157-64"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20274835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Electroconvulsive therapy in patients with aortic stenosis. 主动脉瓣狭窄患者的电痉挛治疗。
Convulsive therapy Pub Date : 1997-09-01
K G Rasmussen
{"title":"Electroconvulsive therapy in patients with aortic stenosis.","authors":"K G Rasmussen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Aortic stenosis confers an increased risk of complications during procedures with general anesthesia. There are no previously reported cases of electroconvulsive therapy (ECT) in patients with this valvular defect. Two cases are described of patients with moderate to severe aortic stenosis confirmed by echocardiography in whom courses of ECT resulted in clinical improvement without untoward cardiac complications. It is concluded that ECT can be safely given to patients with aortic stenosis in whom left ventricular function is normal.</p>","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 3","pages":"196-9"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20274732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The effect of esmolol on ST-segment depression and arrhythmias after electroconvulsive therapy. 艾司洛尔对电惊厥后st段抑制及心律失常的影响。
Convulsive therapy Pub Date : 1997-09-01
D A Zvara, R F Brooker, W V McCall, A S Foreman, C Hewitt, B A Murphy, R L Royster
{"title":"The effect of esmolol on ST-segment depression and arrhythmias after electroconvulsive therapy.","authors":"D A Zvara,&nbsp;R F Brooker,&nbsp;W V McCall,&nbsp;A S Foreman,&nbsp;C Hewitt,&nbsp;B A Murphy,&nbsp;R L Royster","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Electroconvulsive therapy (ECT) induces sympathetically mediated hemodynamic alterations that can be associated with myocardial ischemia and arrhythmia generation. Esmolol, a short-acting beta-blocker, blunts the hypertension and tachycardia seen with ECT. The purpose of this study is to determine whether esmolol use during ECT reduces the incidence of myocardial ischemia or arrhythmias after ECT. In a randomized, double-blind, placebo-controlled protocol, with each patient acting as his/her own control, the effects of esmolol on the incidence of myocardial ischemia and arrhythmias were studied using two-lead Holter monitoring for at least 2 h post-ECT. Nineteen patients underwent 71 ECT treatments (34 placebo, 37 esmolol), recording 746 h of Holter data. The esmolol group had significantly reduced heart rate and mean arterial pressure immediately after ECT. There was no difference in the incidence of ECG defined ischemia post-ECT between groups, with 7 of 19 (36.8%) patients in the esmolol group showing ST-segment depression compared with 5 of 19 (26.3%) in the placebo group. There was no difference between groups in arrhythmia detection. This experiment demonstrates that (a) ECT is associated with a significant incidence of ST-segment depression, (b) esmolol blunts the sympathetic discharge during ECT, and (c) esmolol does not reduce the incidence of post-ECT ischemia or arrhythmia.</p>","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 3","pages":"165-74"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20274836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Postictal neurogenic pulmonary edema: experience from an ECT model. 后神经源性肺水肿:电痉挛模型的经验。
Convulsive therapy Pub Date : 1997-09-01
S L Wayne, C A O'Donovan, W V McCall, K Link
{"title":"Postictal neurogenic pulmonary edema: experience from an ECT model.","authors":"S L Wayne,&nbsp;C A O'Donovan,&nbsp;W V McCall,&nbsp;K Link","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Neurogenic pulmonary edema (NPE) is thought to rarely occur after seizures. Paradoxically, NPE is frequently found (>80%) at autopsy in epileptic patients who die unexpectedly. The reason for the discrepancy between the frequency of NPE found at autopsy and that after uncomplicated seizures is unclear. The literature suggests that subclinical NPE occurs rarely after uncomplicated seizures and resolves within a few hours, but is undetected because of infrequent use of routine chest radiographs early after a seizure occurs. This pilot study examined the frequency of subclinical, radiographically confirmed NPE after electroconvulsive therapy (ECT)-induced seizures. If shown to occur, ECT-induced subclinical NPE would provide an easily reproducible model to study NPE after seizures in patients with epilepsy. Given that sudden unexplained death syndrome accounts for approximately 10% of the deaths in patients with epilepsy, an easily reproducible model for NPE would have heuristic value. We examined 12 patients undergoing ECT for depression with chest radiographs before and after ECT. In this group, only 1 of the 12 patients had subclinical NPE in their post-ECT radiograph. We conclude that subclinical NPE does not significantly occur after seizures in patients undergoing ECT and therefore, would not serve as an application for research.</p>","PeriodicalId":79333,"journal":{"name":"Convulsive therapy","volume":"13 3","pages":"181-4"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20274729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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