title: Electrocardiographic changes in elderly patients during endoscopic retrograde cholangiopancreatography.
abstract: BACKGROUND
  Cardiorespiratory complications may occur during gastrointestinal endoscopy, and elderly people seem to be more vulnerable to these complications during endoscopic procedures involving the manipulation of abdominal viscera.
  
  
  OBJECTIVE
  To determine the incidence of cardiac arrhythmias, changes in oxygen saturation, heart rate and blood pressure during endoscopic retrograde cholangiopancreatography (ERCP) via Holter monitoring in elderly patients older than 70 years of age.
  
  
  METHODS
  Holter monitoring and 12-lead electrocardiograms were performed in 30 elderly patients undergoing ERCP and in 30 control subjects undergoing routine chest, abdomen, bone and upper gastrointestinal small bowel follow-through studies. A computerized nontriggered template system was used to analyze the electrocardiograms qualitatively and quantitatively. Arrhythmias, cardiac axis, conduction defects, pauses, ST segment changes, ectopic beats, oxygen desaturation and changes in blood pressure and rate-pressure product were evaluated.
  
  
  RESULTS
  Increased heart rate, ST segment changes resulting from myocardial ischemia, oxygen desaturation and transient atrial and ventricular ectopic beats were frequent during ERCP compared with the control group. In one patient, transient left bundle branch block developed and this was attributed to pre-existing hypertension with cardiomegaly. One patient developed ventricular tachycardia and one other sinus bradycardia, but this was attributed to sick sinus syndrome.
  
  
  CONCLUSIONS
  Transient myocardial ischemia and various cardiac arrhythmias are frequent in elderly patients undergoing ERCP. Appropriate noninvasive monitoring seems to be justified during this procedure.
authors.affiliation: School of Health, Patras Highest Institute of Education and Technolgy, Patras, Greece. ngkounis@otenet.gr
authors.forename: N G
authors.initials: NG
authors.lastname: Kounis
authors.forename: G M
authors.initials: GM
authors.lastname: Zavras
authors.forename: P J
authors.initials: PJ
authors.lastname: Papadaki
authors.forename: S N
authors.initials: SN
authors.lastname: Kouni
authors.forename: M
authors.initials: M
authors.lastname: Batsolaki
authors.forename: G V
authors.initials: GV
authors.lastname: Gouvelou-Deligianni
authors.forename: C
authors.initials: C
authors.lastname: Markoglou
authors.forename: J A
authors.initials: JA
authors.lastname: Goudevenos
authors.forename: C N
authors.initials: CN
authors.lastname: Mallioris
authors.forename: C
authors.initials: C
authors.lastname: Kokkinis
authors.forename: K
authors.initials: K
authors.lastname: Kalokairinou
authors.forename: N
authors.initials: N
authors.lastname: Grapsas
authors.forename: G N
authors.initials: GN
authors.lastname: Kounis
authors.forename: C M
authors.initials: CM
authors.lastname: Koutsojannis
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology; D001794:Blood Pressure; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate; D006801:Humans; D015994:Incidence; D008297:Male; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology; D010100:Oxygen / Q000097:blood
chemical_list: D010100:Oxygen