Emergency endoscopy for upper gastrointestinal bleeding in patients with coronary artery disease
Journal
American Journal of Emergency Medicine
Journal Volume
27
Journal Issue
7
Pages
802-809
Date Issued
2009
Author(s)
Yan-Zhen Liu A.
Chang D.-C.
Lin J.-T.
Abstract
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. ? 2009 Elsevier Inc. All rights reserved.
SDGs
Other Subjects
adrenalin; aged; ambulatory monitoring; angina pectoris; article; autonomic nervous system function; cardiovascular response; cardiovascular risk; clinical trial; clip; comorbidity; congestive heart failure; controlled clinical trial; controlled study; coronary artery disease; disease severity; electrocardiography monitoring; emergency care; female; gastrointestinal endoscopy; heart muscle ischemia; heart rate variability; heart supraventricular arrhythmia; heart ventricle arrhythmia; hemostasis; human; major clinical study; male; peptic ulcer bleeding; priority journal; risk assessment; ST segment; thermocoagulation; treatment outcome; upper gastrointestinal bleeding; Aged; Aged, 80 and over; Autonomic Nervous System; Comorbidity; Coronary Artery Disease; Electrocardiography, Ambulatory; Emergency Medical Services; Endoscopy, Gastrointestinal; Female; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Male; Middle Aged; Prospective Studies; Risk Factors
Type
journal article