Silent Myocardial Ischaemia during Endoscopic Retrograde Cholangiopancreatography

Johnston, S D; McKenna, Ariel; Tham, Tck

doi:10.1055/s-2003-44597

Cited by 42 publications

(38 citation statements)

References 10 publications

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“…Mechanical effects of the use of a duodenoscope may also stimulate the sensorial afferents while it moves down the esophagus and may cause myocardial ischemia (22,23). Jonston showed that myocardial ischemia developed in approximately 25% of ERCP patients, half of whom had no previous cardiac history (15). Silent myocardial ischemia has been reported in the literature with different frequencies.…”

Section: Discussionmentioning

confidence: 99%

“…Silent myocardial ischemia has been reported in the literature with different frequencies. Vieire found a 2% frequency in 50 patients (13); Lee detected a 18.3% frequency; among 71 patients, one of whom had a myocardial infarction (14), Johnston detected 22% in 41 patients (15); and Fisher reported 8%, of whom 2 died (16). Changes of ST wave in the ECG may not be related with a pre-existing cardiac problem (18).…”

Section: Discussionmentioning

confidence: 99%

“…Changes of ST wave in the ECG may not be related with a pre-existing cardiac problem (18). Johnston found that 22% of his patients had developed ST depression, of whom 10% showed >2 mm depression and over half had no previous cardiac history (15). In a study, cardiac ischemia occurred in 13 patients (18.3%) during ERCP, and one patient developed myocardial infarction; in this study, patients were mostly from the ischemic group than in the non-ischemic group (38.5% vs. 5.2%) (14).…”

Section: Discussionmentioning

confidence: 99%

“…Retrosternal pain and myocardial ischemia have been documented in some patients during ERCP (13)(14)(15). Fisher et al (16) reported that myocardial injury was observed in 8% of procedures after ERCP, as evidenced by an elevation in serum cardiac troponin-I, and that myocardial ischemia might be associated with post-ERCP pancreatitis.…”

Section: Introductionmentioning

confidence: 99%

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Role of serum myeloperoxidase, CPK, CK-MB, and cTnI tests in early diagnosis of myocardial ischemia during ERCP

Yıldız

İnce²,

Kemik³

et al. 2014

Turk J Gastroenterol

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Background/Aims: Some patients may experience retrosternal pain during ERCP, which may be a pioneer of a serious myocardial problem, and early diagnosis is very important for the prognosis and management. In the study, we aimed to investigate the role of serum cardiac biomarkers, such as myeloperoxidase (MPO), creatine phospokinase (CPK), creatine kinase-myocardial band (CK-MB), and cTnI, on early diagnosis of myocardial ischemia during endoscopic retrograde cholangio pancreaticograpy (ERCP) procedures. Materials and Methods: In this prospective observational study, ERCP patients were separated into ischemic cardiac (n:48) and non-ischemic (n:76) groups. Serious cardiac, kidney, and liver disease patients were excluded from the study. Changes in electrocardigrapy (ECG), blood pressure, pulse rate, oxygen saturation, and serum MPO, CPK, CK-MB, and cTnI levels were investigated before and after the ERCP. Results were evaluated statistically (p<0.05). Results: Mean age was 59.76±16.62 (55♀, 69♂). Only one patient had clinically unimportant retrosternal pain (0.8%). ST-elevation was detected in 10.4% (n:5), ST-depression in 12.5% (n:6), and negative-T in 31.3% (n:15) of ischemic patients during ERCP. Systolic and diastolic blood pressure and pulse rates in both groups and oxygen saturations in the ischemic group were reduced after ERCP. Significance was not detected with MPO and CPK tests. CK-MB levels showed an increase after the ERCP in the non-ischemic group (p<0.001). cTnI means were higher among the ischemics when pre-and post-ERCP periods (p:0.001) were compared. Conclusion: Clinically unimportant retrosternal pain, T negativity, and ST segment changes as well as reduced systolic, diastolic blood pressure, and heart rates can be seen during ERCP. MPO and CPK levels remain insignificant if myocardial injury does not develop. Increased CK-MB levels in non-ischemic patients and increased cTnI levels in ischemics may be seen.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of serum myeloperoxidase, CPK, CK-MB, and cTnI tests in early diagnosis of myocardial ischemia during ERCP

Yıldız

İnce²,

Kemik³

et al. 2014

Turk J Gastroenterol

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“…In a study with 41 patients undergoing ERCP under conscious sedation, Johnston et al [37] revealed that one quar ter of patients had myocardial ischemia and over half of them had no previous cardiac history and normal baseline electrocardiography results.…”

Section: Assessing Sedation-related Complicationsmentioning

confidence: 99%

Deep sedation for endoscopic retrograde cholangiopacreatography

Chainaki¹

2011

WJGE

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Sedation and analgesia comprise an important element of unpleasant and often prolonged endoscopic retro grade cholangiopacreatography (ERCP), contributing, however, to better patient tolerance and compliance and to the reduction of injuries during the procedure due to inappropriate cooperation. Although most of the studies used a moderate level of sedation, the lite rature has revealed the superiority of deep sedation and general anesthesia in performing ERCP. The anes thesiologist's presence is mandatory in these cases. A moderate sedation level for ERCP seems to be adequate for octogenarians. The sedative agent of choice for sedation in ERCP seems to be propofol due to its fast distribution and fast elimination time without a cumu lative effect after infusion, resulting in shorter recovery time. Its therapeutic spectrum, however, is much nar rower and therefore careful monitoring is much more demanding in order to differentiate between moderate, deep sedation and general anesthesia. Apart from con ventional monitoring, capnography and Bispectral index or Narcotrend monitoring of the level of sedation seem to be useful in titrating sedatives in ERCP.

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ERCP: Risks, Prevention, and Management

Cotton¹

2005

Advanced Digestive Endoscopy: ERCP

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Silent Myocardial Ischaemia during Endoscopic Retrograde Cholangiopancreatography

Cited by 42 publications

References 10 publications

Role of serum myeloperoxidase, CPK, CK-MB, and cTnI tests in early diagnosis of myocardial ischemia during ERCP

Role of serum myeloperoxidase, CPK, CK-MB, and cTnI tests in early diagnosis of myocardial ischemia during ERCP

Deep sedation for endoscopic retrograde cholangiopacreatography

ERCP: Risks, Prevention, and Management

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