title: Myocardial ischemia during endoscopic retrograde cholangiopancreatography - A real problem?
abstract: OBJECTIVE
  The occurrence of silent myocardial ischemia during endoscopic retrograde cholangiopancreatography (ERCP) has been documented, but its clinical significance remains unknown. The aims of this study were to investigate the incidence and risk factors of myocardial ischemia during ERCP, to determine the presence or absence of permanent myocardial injury and to evaluate if deep sedation with propofol had a positive effect on myocardial ischemia during ERCP.
  
  
  METHODS
  Ambulatory ST-segment monitoring from 30 minutes prior to 4 hours after ERCP was obtained on 50 patients. A deep sedation was performed with intravenous propofol administered by anesthesiologist. Changes in vital signs during ERCP, pre and postprocedural 12-lead ECG examination and cardiac enzymes were evaluated.
  
  
  RESULTS
  Silent cardiac ischemia occurred only in one patient (2%) during ERCP. This 64-year-old patient did not develop hypoxemia, tachycardia or hypotension periods during the exam. None of the patients developed cardiac enzymes or postprocedural electrocardiographic changes. Thirty seven (74%) patients suffered rhythm changes.
  
  
  CONCLUSIONS
  Although rhythm disturbances were common, silent myocardial ischemia during ERCP was rare (2%) and without clinical relevance. In prolonged or complex therapeutic procedures, like ERCP, deep sedation with propofol performed by trained personnel is associated with reduced cardiac complications.
authors: Department of Gastroenterology, Centro Hospitalar de Setúbal, Hospital de São Bernardo, Setúbal, Portugal. ana.amdsv@gmail.com
authors: A M
authors: AM
authors: Vieira
authors: N
authors: N
authors: Matias
authors: M I
authors: MI
authors: Cremers
authors: J
authors: J
authors: Mangualde
authors: R
authors: R
authors: Freire
authors: J
authors: J
authors: Cortez
authors: C
authors: C
authors: Carradas
authors: I
authors: I
authors: Silvestre
authors: A P
authors: AP
authors: Oliveira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D054810:Deep Sedation; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult