Thoracic cavity irrigation: an unusual cause of acute ST segment increase

Our plain-English summary of Thoracic cavity irrigation: an unusual cause of acute ST segment increase, by M.J. Brown, D.R. Brown (Anesthesia and Analgesia, 2002).

The study

• Authors: M.J. Brown, D.R. Brown
• Journal: Anesthesia and Analgesia
• Published: 2002;95(3):552-4, table of contents
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We describe an unusual case of acute ST segment increase secondary to warm saline thoracic cavity irrigation during thoracotomy. Temperature-mediated alteration of myocyte repolarization should be considered in addition to myocardial ischemia when ST segment changes occur.

In plain English

This was a case report from the Department of Anesthesiology at the Mayo Clinic about one patient: a 55-year-old woman having an operation called a right extrapleural pneumonectomy for mesothelioma. The article did not discuss asbestos or the cause of her mesothelioma. Its subject was a heart-tracing (ECG) change during the operation. When the surgeon rinsed the right chest cavity with warm saline, her ECG suddenly showed ST segment increase of 6 mm in leads II and III. Her esophageal temperature rose from 35.5°C to 42.4°C. Her heart rate and blood pressure did not change. After the fluid was removed, her temperature and ECG returned to baseline over about 4 minutes. A second, 4 mm episode occurred during a later rinse. Afterward, neither the ECG nor CPK-MB/CPK criteria showed evidence of a heart attack, and she was discharged 7 days later. The authors concluded that the ECG changes seemed to have been caused by local warming of the heart muscle. The temperature of the rinse fluid was never directly measured.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 55-year-old woman undergoing right extrapleural pneumonectomy for mesothelioma, with no significant coronary risk factors, at the Mayo Clinic, Rochester, Minnesota
• Exposure: Not asbestos. The exposure examined was irrigation of the open right chest cavity with warm saline during surgery; the irrigant temperature was not measured but was inferred to be at least 42.4°C
• Main results:
  • During the first irrigation, the patient's ECG showed sudden inferior ST segment increase of 6 mm in leads II and III
  • During the first irrigation, the patient's esophageal temperature rose from 35.5°C to 42.4°C
  • The patient's hemodynamic variables did not change during the ST segment increase
  • After the irrigant was removed, the patient's esophageal temperature and ST segment returned to baseline over 4 minutes
  • A second episode of 4 mm ST segment increase occurred in the same patient during a later irrigation, with esophageal temperature rising to 40.3°C
  • After surgery, there was no evidence of myocardial infarction by postoperative ECG or CPK-MB/CPK criteria
  • The patient was discharged home 7 days later
• The authors' conclusion: The authors concluded that the ECG changes seemed to have been caused by focal warming of the heart muscle from the warm irrigation fluid
• Limitations the authors state:
  • The temperature of the irrigation solution was not directly measured
  • Troponin I concentrations were not measured
  • The authors acknowledged that coronary spasm could account for the ST segment changes, though they considered it less likely

Topics

Medical terms in this study, explained in our Lexicon: Thoracotomy.

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