Does Gastroscopy Induce Myocardial Ischemia in Patients With Coronary Heart Disease?

Abstract

Gastroscopy is potentially a harmful procedure for CHD patients, but the incidence of ischemic periods may be reduced by conscious sedation and, if the patient is receiving beta-blocking agent therapy, by applying this medication prior to gastroscopy.

Risk Factors for Hypoxemia During Ambulatory Gastrointestinal Endoscopy in ASA I–II Patients

“…Overall, conscious sedation is overwhelmingly safe, with a very low risk of death, requirement for artificial ventilation, myocardial infarction, or central nervous system damage. Therefore, hypoxemia is used as a surrogate for these outcomes due to rarity of these hard events and also because hypoxemia is a precursor to these outcomes [16][17][18][19]. As the majority of studies included heterogeneous patient groups, further risk factor assessment in these studies has been potentially confounded by the strong influence of ASA class.…”

Peptic Ulcer Disease in Dyspeptic Patients with Ischemic Heart Disease: Search and Treat?

“…Thus, the symptoms of gastroduodenal dyspepsia, when specifically sought by a physician during structured interview with the patients, could identify the group of IHD patients with PUD prevalence of 37.5 %. A recent study by Schenck et al included 71 patients with IHD in whom gastroscopy was performed to assess the potentially harmful effects of the procedure in IHD patients [11]. Study results showed gastroscopy to be a safe procedure in patients with stable IHD, although they had a very high rate of silent myocardial ischemia during endoscopy.…”

Upper Gastrointestinal Symptoms and Cardiovascular Disease

“…However, endoscopy has been shown to induce cardiovascular complications, including myocardial ischemia [40,41,54]. Thus, this practice may serve as an additional explanation for the frequent diagnosis of cardiovascular disease in patients experiencing upper gastrointesti-nal symptoms.…”

“…However, more recent studies in patients with stable coronary disease or those at risk for cardiovascular disease have observed much higher rates of cardiovascular complications following endoscopy. In a study of 71 patients with stable coronary heart disease undergoing endoscopy for evaluation for the safety of secondary prophylaxis with aspirin, 42% of patients experienced silent ischemia and one patient had a symptomatic event [40]. A second study utilizing data from 9 hospitals in the United States evaluated 602 charts for patients undergoing endoscopy and deemed to be at risk for cardiovascular disease.…”

“…Next, patients experiencing both health problems often complain of similar or overlapping symptomatology, potentially resulting in the more frequent surveillance and diagnosis of both [38]. Related to this, some studies have suggested that common means of investigating upper gastrointestinal symptom origin can aggravate some cardiovascular diseases or induce cardiovascular symptoms [39,40]. Finally, polypharmacy with drugs used to manage cardiovascular diseases can cause upper gastrointestinal symptoms [8,[41][42][43][44][45][46] resulting in decreased adherence to their medications, and a perhaps initiating a cycle of recurrence/worsening of cardiovascular disease.…”