Abnormal postoperative electrocardiograms are not uncommon, oftentimes leading to further cardiac workup especially when the findings are new and not easily explainable. A forty-year-old woman, with a history of left breast cancer status post bilateral mastectomies and reconstructions, presented for robot-assisted low-anterior resection secondary to rectal cancer. Postoperative electrocardiogram showed poor R wave progression, biphasic T waves in V2-4, and possible anterior wall ischemia. Her electrocardiogram from 6 years ago was normal. No recent electrocardiogram was available for comparison. Initially, the abnormal postoperative electrocardiogram appeared worrisome. However, the patient was completely asymptomatic, and all vital signs were normal. Cardiac point-of-care ultrasound showed normal parasternal long and short axis views. The biphasic T waves in V2-4 were suggestive of Wellens syndrome, but the accompanying poor R wave progression was not consistent with the diagnostic criteria. The anesthesiologist then remembered the patient's history of the presence of a left breast implant and suspected it might have caused the changes on the electrocardiogram. A literature search did find one publication that shows approximately 45% of patients with breast implants present with electrocardiogram changes, including poor R wave progression and negative T waves. Therefore, no further cardiac workup was ordered for our patient. She was discharged home 3 days later. Breast implants and electrocardiogram changes are a lesser-known topic. Obtaining a pre-operative electrocardiogram should be considered in patients with previous breast implants, to serve as a baseline for comparison if the patient were to need another electrocardiogram in the future.

中文翻译：

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术后心电图变化：担心还是不担心

术后心电图异常并不少见，通常会导致进一步的心脏检查，尤其是当发现的结果是新的且不易解释时。一名四十岁的女性，在双侧乳房切除和重建后有左乳腺癌病史，因直肠癌接受机器人辅助低位前切除术。术后心电图显示R波进展不良，V2-4为双相T波，可能存在前壁缺血。6年前的心电图正常。没有最近的心电图可供比较。最初，术后心电图异常令人担忧。然而，患者完全无症状，所有生命体征均正常。心脏护理点超声显示胸骨旁长轴和短轴视图正常。V2-4 的双相 T 波提示 Wellens 综合征，但伴随的 R 波进展不良与诊断标准不符。麻醉师随后记起了患者左乳房植入物的病史，并怀疑这可能导致了心电图的变化。文献检索确实发现一份出版物显示，大约 45% 的乳房植入物患者出现心电图变化，包括 R 波进展不良和 T 波负。因此，没有为我们的患者安排进一步的心脏检查。3天后，她出院回家。乳房植入物和心电图变化是一个鲜为人知的话题。对于曾经做过乳房植入手术的患者，应考虑进行术前心电图检查，以作为患者将来需要再次进行心电图检查时进行比较的基线。