Perioperative bradycardia and asystole in a 50 year old athletic female who underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy under continuous lumbar epidural anesthesia / Thera Janick L. Ramirez.

Includes bibliographical references.

Abstract: There is aunique electrical manifestationassociated with regular and long term participation in intensive exercise, minimum of 4 hours per week, that reflect increased vagal tone and enlarged cardiac chamber size, often observed in athletes. Athletic bradycardia is often ignored because these ECG findings in athletes are considered normal, and physiological adaptations to regular exercise do not require further evaluation1.Common consequences of increased vagal tone include sinus bradycardia and sinus arrhythmia. This is a case of a 50 year old female diagnosed with myoma uteri, who underwent TAHBSO under continuous lumbar epidural anesthesia. She worked as a fitness instructor, with previous episodes of syncope and has a baseline heart rate of 40s to 50s beats per minute. During induction, she had loss of consciousness associated with sinus bradycardia and later on, to asystole which lasted for 3 seconds, with return to baseline heart rate after administration of atropine and ephedrine. The objectives of this report are: 1. To explain the physiological changes in the cardiovascular system of a physically active individual. 2. To explain the possible association of athletic bradycardia to vasovagal syncope in this particular patient.

Research - Department of Anesthesiology