Use of electroconvulsive therapy in an elderly after 5 weeks of myocardial infraction with 30% cardiac output

Abstract

There is limited literature on the use of electroconvulsive therapy (ECT) in patients with recent myocardial infarction and in those with reduced cardiac output. In this report, we describe the safe use of ECT in a 70-year-male suffering from severe depressive episode with psychotic symptoms. He had a history of poor response to adequate pharmacotherapy and had suffered from myocardial infraction (MI), about 3 weeks prior to admission to the psychiatric unit. In view of severe depression associated with marked anxiety, agitation, psychotic symptoms, and poor food intake he was started on ECT after 5 weeks of MI when his cardiac output was only 30%. He received nine sessions of ECT without any cardiac complications and his depression remitted with ECT.

Anesthesia Management of Special Patient Populations Undergoing Electroconvulsive Therapy: A Review

“…Grover et al 26 concluded that the experience with their patient with severe depression suggests that ECT can be safely given in patients with recent MI and/or reduced cardiac output with proper monitoring, and their case adds to the limited literature on the safe use of ECT in such patients. However, this author believes that ECT clinicians must consider the risk-benefit ratio when treating high-risk and medically complicated patients 7 .…”

“…There are limited reports on the use of ECT in patients with recent MI and in those with reduced cardiac output 26 . Use of ECT is associated with an increase in cardiac output, rise in blood pressure, and increase in heart rate lasting for a few minutes 1 3,6,7, 26 . Accordingly, a thorough cardiac evaluation is considered to be mandatory prior to the use of ECT 7,26 .…”

“…Use of ECT is associated with an increase in cardiac output, rise in blood pressure, and increase in heart rate lasting for a few minutes 1 3,6,7, 26 . Accordingly, a thorough cardiac evaluation is considered to be mandatory prior to the use of ECT 7,26 . Generally, the guidelines given by the American College of Cardiology/American Heart Association for non-cardiac procedures requiring general anesthesia are also followed for ECT 27,28 , and these guidelines suggest that acute MI within one week or severe MI within the last four weeks is associated with an increase in perioperative morbidity.…”

“…In some case reports, authors reported the successful use of ECT after 10 days, 30 days, and 5 weeks after the MI 26 . Grover et al 26 also commented that in terms of the use of ECT in patients with reduced cardiac output, again the data are sparse, and only one study has presented the data on such patients 29 .…”

“…In some case reports, authors reported the successful use of ECT after 10 days, 30 days, and 5 weeks after the MI 26 . Grover et al 26 also commented that in terms of the use of ECT in patients with reduced cardiac output, again the data are sparse, and only one study has presented the data on such patients 29 . According to this study, ECT was used in 35 patients, aged 54-92 years with low cardiac output and median left ventricular (LV) ejection fractions ranging from 15 to 40% but without cardiac complications such as decompensated heart failure, myocardial ischemia, or MI, either during the ECT procedure or 24 hours thereafter.…”