Does gastroscopy induce myocardial ischemia in patients with coronary heart disease?
OBJECTIVE
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.


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To predict potential ischemia during gastroscopy, the Holter monitoring ECG was applied prior to a treadmill test, and withdrawn after gastroscopy 16-22 hours later.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.
Schenck
J
J
Dept. of Internal Medicine, Municipal Clinic of Lüneburg, Germany.
Müller
C H
CH
Lübbers
H
H
Mahlke
R
R
Lehnick
D
D
Lankisch
P G
PG
D000328:Adult; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory; D004935:Esophageal Diseases / Q000175:diagnosis; D005080:Exercise Test; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005773:Gastroscopy / Q000009:adverse effects*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D011379:Prognosis; D012307:Risk Factors; D013272:Stomach Diseases / Q000175:diagnosis
D005343:Fibrinolytic Agents; D001241:Aspirin