Emergency endoscopy for upper gastrointestinal bleeding in patients with coronary artery disease.
BACKGROUND
Endoscopy is useful for diagnosis and treatment of upper gastrointestinal bleeding (UGIB). However, both endoscopy and UGIB may compromise the cardiovascular function. The present study is to investigate the cardiovascular responses of emergency endoscopy for patients with UGIB and stable coronary artery disease (CAD).


METHODS
Consecutive 50 patients with known CAD and 50 patients without CAD history (non-CAD group) in whom emergency endoscopy was requested for UGIB were prospectively enrolled. All patients received ambulatory electrocardiographic monitoring before, during, and after endoscopies. Cardiac indices including supraventricular and ventricular arrhythmia, ST ischemic change, and autonomic nervous function evaluated by heart rate variability were compared.


RESULTS
All patients in both groups had successful primary hemostasis, and peptic ulcer bleeding was the main etiology (82%). Compared with the non-CAD group, patients with CAD had a significantly higher incidence (42% vs 16%, P = .004) and frequency (1.19 vs 0.12 events per minute, P = .003) of ventricular arrhythmias during endoscopy. Nine patients with CAD and 1 patient without CAD had ischemic ST changes (P = .016). Comorbidity with congestive heart failure was not only associated with a higher frequency (P = .02) but also a more severe fluctuation (P = .002) of ventricular arrhythmia. None in both groups had angina or MI before, during, or after endoscopy. Heart rate variability did not show a difference.


CONCLUSIONS
Ventricular arrhythmias and myocardial ischemia, although mostly subclinical, were common in patients with stable CAD undergoing emergent endoscopy for UGIB, especially in those with concomitant congestive heart failure.
Tseng
Ping-Huei
PH
Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin County 640, Taiwan.
Liou
Jyh-Ming
JM
Lee
Yi-Chia
YC
Lin
Lian-Yu
LY
Yan-Zhen Liu
Alyssa
A
Chang
Dun-Cheng
DC
Chiu
Han-Mo
HM
Wu
Ming-Shiang
MS
Lin
Jaw-Town
JT
Wang
Hsiu-Po
HP
D000368:Aged; D000369:Aged, 80 and over; D001341:Autonomic Nervous System / Q000503:physiopathology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology*; D015716:Electrocardiography, Ambulatory; D004632:Emergency Medical Services; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000601:surgery*; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors