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ECT: Cardiac effects

Cardiac Effects Following ECT stimulus

  1. Initial tonic phase is characterized by profound stimulation of the parasympathetic nervous system which can result in
    1. Sinus bradycardia
    2. Brief episode of hypotension
    3. Occasional premature atrial and ventricular beats
  2. This is followed by a sympathetic surge (which accompanies the seizure) resulting in:
    1. Tachycardia (peaks at two minutes post stimulus)
    2. Hypertension (a rise of 20-80 mmHg from baseline systolic blood pressure)
    3. ST depression and or T-wave inversion
      1. Not typically associated with troponin rise
      2. Very rarely develop into ventricular tachycardia
  3. Medications such as esmolol (0.15-1.5mg/kg IV) or labetolol (0.13mg/kg IV) can be given prior to the induction of seizure to help prevent the cardiac effects of the sympathetic surge.
  4. Very Rare Outcomes
    1. Takotsubo Cardiomyopathy (TCM)
      1. Thought to be related in part to excessive levels of plasma catecholamines
      2. Typically treated with B-blockers, aspirin, nitrates and heparin; vasopressors if cardiac function is significantly reduced
      3. ACC/AHA recommends discontinuation of repeat ECT therapy in acute setting of TCM. However, a history of TCM after ECT is not an absolute contraindication to a retrial of ECT, especially when all other pharmacologic options have been exhausted.