Electrocardiographic changes during cholangiopancreatography: CONCLUSIONS

Therefore, it seems that the ST segment changes of the 16 patients were related to both hypoxaemia and sinus tachycardia. It has been suggested 41 that the development of myocardial ischemia during ERCP, manifesting an ST segment deviation, is related to increase cardiac oxygen demand caused by tachycardia rather than decreased oxygen supply caused by hypoxaemia. Our data cannot support this suggestion. We did not use beta-blockade in order to reduce the tachycardia in our patients because this was not the aim of this study. Beta-blockers reduce heart rate, increase cardiac diastolic filling and improve blood oxygen supply to myocardium. Therefore, beta-blockers have been used to prevent tachycardia during endoscopy. Metoprolol is a beta-blocker which has been used in a double blind randomized controlled trial during ERCP in peripheral vascular surgery and after cardiac operations, with positive effect on myocardial oxygen supply and incidence of myocardial ischemia. Beta-blockers have also a strong anxiolytic effect comparable with benzodiazepimes but without concurrent sedation.

We believe that the encountered electrocardiographic abnormalities and myocardial ischemia during ERCP in elderly patients, are common and usually transient. Clinical evidence of prior heart disease seems to be predisposing factor for these abnormalities. The procedure requires careful evaluation of the risks especially in the elderly people with preexisting cardiac disease. A careful history especially of the cardiovascular system should be obtained in all patients. Non invasive monitoring during the procedure and appropriate clinical observation by the cardiologist, endoscopist and radiologist will result in safer examination and seems to be justified. You can finally shop for your efficient generic levitra professional cialis professional with the best online pharmacy there could be, getting all the bonuses and special offers that every customer enjoys because of how moneysaving and secure it all can be.

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