The frequency and significance of silent myocardial ischemia due to hyoscine butylbromide use in peripheral angiography.
OBJECTIVE
Hyoscine-N-butylbromide (HB) is an anticholinergic drug used in digital subtraction angiography of the aortoiliac region because it decreases bowel gas movement artifact. HB also causes an increase in heart rate. We investigated whether this could cause silent myocardial ischemia (SMI) in susceptible patients during peripheral angiography.


METHODS
Thirty-six patients undergoing peripheral angiography were randomized into two groups, with 17 patients receiving 20 mg HB intraarterially during the angiogram and 19 patients receiving no drug. All patients were fitted with a Holter monitor that recorded the electrocardiogram before, during, and after the angiogram. Heart rate trends and ST segments were then analyzed.


RESULTS
Patients given HB had a statistically significant rise in heart rate compared with the control group. Although the difference was not statistically significant, two (12%) patients receiving HB had procedural ST depression compared with none in the control group. Pre- and postprocedural episodes of ST depression were common, occurring in 41% of patients receiving HB and 37% of patients receiving no drug, and were associated with an increase in heart rate.


CONCLUSIONS
The infrequent episodes of procedural SMI, potentially caused by the positive chronotropic effects of HB, are probably insignificant when compared with the high frequency of SMI episodes occurring outside the procedure.
Maher
R
R
Department of Radiology, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
Phillips-Hughes
J
J
Banning
A
A
Boardman
P
P
D000368:Aged; D015901:Angiography, Digital Subtraction; D001794:Blood Pressure / Q000187:drug effects; D002086:Butylscopolammonium Bromide / Q000008:administration & dosage / Q000009:adverse effects*; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000139:chemically induced*; D010276:Parasympatholytics / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies
D010276:Parasympatholytics; D002086:Butylscopolammonium Bromide