[ST trend analysis. Monitoring of risk patients?].

ST-segment monitoring has been proved to be an effective tool in detecting silent myocardial ischaemia, which is an important factor for perioperative cardiac morbidity. The case of a 72-year-old patient with peripheral vascular disease who underwent iliaco-femoral bypass surgery due to acute occlusion of a existing femoropopliteal bypass is reported. As part of a study the patient had perioperative ST-segment holter monitoring which showed pre-, peri- and postoperative severe episodes of silent myocardial ischaemia. No episode was accompanied by anginal symptoms. Post-operatively, a long-lasting episode of severe ST-segment deviation with complex arrhythmias occurred, resulting in cardiac failure and lung oedema. This ST-segment deviation began when the surgical procedure had been concluded and the patient extubated. The peak of the deviation occurred during transport from the operating room the recovery room. The existing ECG changes and the raised heart rate, from the beginning of the time in the recovery room to arrival on the normal ward, were not adequately recognized. The lack of clinical symptoms was misinterpreted. Many hours before, ST deviations and higher heart rate could be seen as precursors of a severe cardiac event. This demonstrates the importance of silent ischaemia in the perioperative period and shows the usefulness of ECG monitoring, especially of the ST segment, in detecting silent ischaemia and enabling early treatment.