Emergency endoscopy for upper gastrointestinal bleeding in patients with coronary artery disease |
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Authors: | Ping-Huei Tseng MD Jyh-Ming Liou MD Yi-Chia Lee MD MSc Lian-Yu Lin MD PhD Alyssa Yan-Zhen Liu BBA MSc Dun-Cheng Chang BBA MSc Han-Mo Chiu MD Ming-Shiang Wu MD PhD Jaw-Town Lin MD PhD Hsiu-Po Wang MD |
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Institution: | 1. Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin County 640, Taiwan;2. Departments of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan;3. Division of Biostatistics, Graduate Institute of Epidemiology, and Center of Biostatistics Consultation, College of Public Health, National Taiwan University, Taipei 100, Taiwan;4. Department of Internal Medicine, E-DA Hospital and I-Shou University, Kaohsiung County 824, Taiwan |
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Abstract: | BackgroundEndoscopy 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).MethodsConsecutive 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.ResultsAll 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.ConclusionsVentricular 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. |
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