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Continuous electrocardiographic monitoring during upper gastrointestinal endoscopy
Insights
Esophago-gastro-duodenoscopy (EGD) can cause transient ECG abnormalities in patients, especially those with ischemic heart disease (IHD). Monitoring is advised, with emergency equipment readily available during the procedure.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Procedures
Background:
- Esophago-gastro-duodenoscopy (EGD) is a common diagnostic procedure.
- Patients with ischemic heart disease (IHD) may be at higher risk for complications during EGD.
- Continuous electrocardiographic (ECG) monitoring is crucial for assessing cardiac events during endoscopic procedures.
Purpose of the Study:
- To evaluate the incidence and types of ECG changes during and after EGD.
- To assess the occurrence of cardiac events in patients with and without IHD undergoing EGD.
- To determine the clinical significance of ECG abnormalities detected during EGD.
Main Methods:
- Continuous electrocardiographic monitoring of 69 patients before, during, and after EGD.
- Patient cohort included individuals with and without a history of ischemic heart disease (IHD).
- Analysis of various ECG parameters, including rhythm, conduction, and ST-T wave changes.
Main Results:
- 46.5% of patients (32/69) had pre-existing ischemic heart disease (IHD).
- Various transient ECG abnormalities were observed in a significant number of patients during EGD.
- Only one patient with IHD experienced anginal chest pain; most abnormalities required no intervention.
Conclusions:
- EGD can induce transient cardiac rhythm and conduction abnormalities, particularly in patients with IHD.
- While generally benign, these ECG changes underscore the need for vigilance.
- Availability of resuscitation equipment and emergency drugs during EGD is recommended for patients with IHD.
Abstract:
ECG changes were followed up in 69 patients under continuous electrocardiographic monitoring before, during and after esophago-gastro-duodenoscopy (EGD). Of these 32 (46.5%) had ischemic heart disease (IHD). One or more varied abnormalities including supraventricular or ventricular ectopic beats, sinus tachycardia or sinus bradycardia, intermittent right or left bundle branch block, S--T segment depression (and increased preexisting S--T segment depression), T wave flattening or inversion appeared during EGD. Only one patient with IHD developed anginal chest pain during endoscopy. Despite the high incidence of recorded rhythm abnormalities, these were transient, and no treatments were needed. However, it seems advisable to have resuscitation equipment and emergency drugs available during EGD, particularly when it is performed in patients with IHD.