Does gastroscopy induce myocardial ischemia in patients with coronary heart disease?
J Schenck1, C H Müller, H Lübbers
1Dept. of Internal Medicine, Municipal Clinic of Lüneburg, Germany.
Insights
Gastroscopy can cause silent ischemia in stable coronary heart disease (CHD) patients, but symptoms are rare. Heart rate predicts ischemia risk during the procedure.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Procedures
Background:
- Gastroscopy is considered risky for unstable coronary heart disease (CHD) patients.
- The safety of gastroscopy in stable CHD patients and prediction of ischemia are not well-established.
- Secondary prophylaxis with acetylsalicylic acid (ASA) indications need clarification in this cohort.
Purpose of the Study:
- To assess the risk of myocardial ischemia during gastroscopy in stable CHD patients.
- To determine if ischemia can be predicted before the procedure.
- To evaluate the frequency of abnormal gastroscopic findings and their impact on ASA indication.
Main Methods:
- 71 stable CHD patients underwent Holter monitoring during gastroscopy to detect silent ischemia.
- ECG monitoring was also used before a treadmill test to predict potential ischemia.
- Gastroscopy findings were analyzed for bleeding risk and ASA indication.
Main Results:
- 42% of patients experienced silent ischemia during gastroscopy, with only 1% symptomatic.
- Ischemia correlated with higher heart rates (median 124 bpm vs. 104 bpm).
- 75% of patients had abnormal findings, with 42% indicating bleeding risk and 8% preventing ASA use.
Conclusions:
- Gastroscopy poses a risk of ischemia in CHD patients.
- Conscious sedation and pre-procedural beta-blocker therapy may reduce ischemic events.
- Abnormal findings impact treatment decisions, including ASA prophylaxis.
Background And Study Aims:
Gastroscopy has been reported to be dangerous for unstable patients with coronary heart disease (CHD). The aims of this study were to find out whether endoscopy is equally liable to cause myocardial ischemia in stable CHD patients, and whether this can be predicted prior to endoscopy, and to find out the frequency of abnormal findings in patients for whom a secondary prophylaxis with acetylsalicylic acid (ASA) is indicated.
Patients And Methods:
Electrocardiograph recording using a Holter monitor was performed during gastroscopy in 71 patients with stable CHD, to check for silent ischemia. To predict potential ischemia during gastroscopy, the Holter monitoring ECG was applied prior to a treadmill test, and withdrawn after gastroscopy 16-22 hours later.
Results:
During gastroscopy, 30 patients (42%) had silent ischemia, but only 1 patient (1%) became symptomatic. Ischemia was dependent on heart-rate (median heart rate with ischemia 124 beats/min, without 104 beats/min). Abnormal findings on gastroscopy were found in 53 patients (75%). They implied a potential bleeding risk in 30 patients (42%) and prevented the indication for ASA in 6 of them (8%).
Conclusions:
Gastroscopy is potentially a harmful procedure for CHD patients, but the incidence of ischemic periods may be reduced by conscious sedation and, if the patient is receiving beta-blocking agent therapy, by applying this medication prior to gastroscopy.
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