title: ECG changes during endoscopic retrograde cholangio-pancreatography and coronary artery disease.
abstract: OBJECTIVE
  Myocardial ischaemia has been described during endoscopic retrograde cholangio-pancreatography (ERCP), but the pathogenesis remains unclear. The aim of the present study was to evaluate whether coronary artery disease was present in patients with ST-segment changes during ERCP.
  
  
  METHODS
  Forty patients were monitored with a Holter tape recorder during ERCP. Patients with ST-segment deviation during ERCP subsequently underwent a standard exercise ECG test.
  
  
  RESULTS
  Twelve patients developed signs of myocardial ischaemia during ERCP (30%) and 9 had concomitant tachycardia. None had a cardiac history or cardiorespiratory symptoms. Ten of the 12 patients did an exercise test and one patient developed silent ischaemia. Subsequent coronary angiography showed no evidence of coronary artery disease.
  
  
  CONCLUSIONS
  No signs of existing coronary artery disease were found in patients developing ST deviation during ERCP when evaluated with a 12-lead exercise ECG test. Further studies should evaluate other mechanisms responsible for myocardial ischaemia during ERCP.
authors.affiliation: Department of Surgery and Holter Lab, Hvidovre University Hospital, Hvidovre, Denmark. merete.christensen@dadlnet.dk
authors.forename: Merete
authors.initials: M
authors.lastname: Christensen
authors.forename: Thor
authors.initials: T
authors.lastname: Milland
authors.forename: Verner
authors.initials: V
authors.lastname: Rasmussen
authors.forename: Svend
authors.initials: S
authors.lastname: Schulze
authors.forename: Jacob
authors.initials: J
authors.lastname: Rosenberg
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D015716:Electrocardiography, Ambulatory; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric