Electrocardiographic changes during cholangiopancreatography: DISCUSSION (Part 2)

In one patient asymptomatic supraventricular tachycardia and in another patient a burst of ventricular tachycardia developed but these two patients had ischemic heart disease. The patient who developed sinus bradycardia during ERCP had suffered a previous myocardial infraction and had been diagnosed as having sick sinus syndrome. All patients had diminished blood oxygen saturation and 16 developed ST segment changes compatible with ischemic heart disease.

The mechanisms by which the cardiorespiratory and electrocardiographic changes occur during ERCP remain speculative. During upper gastrointestinal endoscopy airway obstruction, gastric or salivary aspiration, direct pressure on the diaphragm, air insufflation and stress and anxiety triggering catecholamine release may contribute. During ERCP several factors tend to increase sympathetic activity.

Neural impulses from higher centers in the brain may be transient risk factors. The distension and collapse of hollow abdominal viscera during the procedure might be another factor accounting for the electrocardiographic abnormalities. Indeed, ERCP is a method with many applications especially for patients suspected to have billiary and pancreatic problems. However, it involves the insertion of a side-viewing duodenoscope through the oesophagus to the stomach, pylorus, duodenal pulb and papilla. This cannulation involves special manipulations, angulations, air insufflation and sometimes becomes unpleasant to the patient. It has been suggested that the removal of the insufflated air before the removal of the endoscope may lower the risk of cardiovascular problems. The use of a narrow diameter endoscope has been suggested to cause less hypoxia than the standard diameter endoscope. The increased load of the endoscopic examination on the cardiovascular function may be caused by psychological stress before and during examination as well as by the physical effects of the anticholinergic drugs. Indeed, all of our patients were receiving, as premedication, diazepam and Buscopan. You will always find best quality drugs ever, because now you can enjoy your shopping every time you need levitra professional sale with a nice discount and delivery straight to your home, being sure this is the exact treatment your condition requires.

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