Bradycardia and hypotension in a patient with severe aortic stenosis receiving electroconvulsive therapy dose titration for treatment of depression

Aortic stenosis (AS) is a risk factor for increased morbidity and mortality in patients undergoing procedures requiring general anesthesia. The absolute risk to patients with AS receiving electroconvulsive therapy (ECT) is unknown, but given the physiologic changes occurring in AS, it is reasonable to postulate that such patients are at increased risk for untoward events. In this article, we present the case of a 75-year-old woman with severe AS who developed hypotension and bradycardia during ECT dose titration. We discuss practical considerations and risk reduction strategies when using ECT in patients with severe AS.