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Electrocardiographic Changes in Elderly Patients During Small Bowel Enema

ZAVRAS, GEORGE M. MD*; PAPADAKI, PARASKEVI J. MD*; KOUNIS, NICHOLAS G. MD; VASILAKOS, PAVLOS J. MD*; ARTINOPOULOS, CHRISTOS J. MD*; KOUTSOJANNIS, CONSTANTINOS PHD; PANAYIOTAKIS, GEORGE S. PHD*; GOUDEVENOS, JOHN A. MD; FEZOULIDIS, IOANNIS B. MD

Original Investigation
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RATIONALE AND OBJECTIVES Enteroclysis (small bowel enema) involves the introduction of a large amount of fluid into the small bowel, through a tube, producing small bowel distention. A study was done to determine the incidence of any electrocardiographic changes during enteroclysis with Holter monitoring.

METHODS Continuous electrocardiographic monitoring and 12-lead electrocardiograms were performed in 30 elderly patients undergoing enteroclysis and in 30 control subjects undergoing routine chest, bone, and upper gastrointestinal small bowel follow-up studies. Two channel qualitative and quantitative electrocardiographic analysis was performed by a computerized nontriggered template system. Arrhythmias, change in cardiac axis, conduction defects, pauses, ST segment changes, and ectopics were sought.

RESULTS Increased sympathetic tone resulting in increased heart rate and transient atrial and ventricular ectopics was frequent during enteroclysis compared with the control group. In one patient ventricular tachycardia developed, and two patients had diminished heart rate, but this was attributed to preexisting heart disease and concurrent medication.

CONCLUSION Transient, nonhazardous cardiac arrythmias are encountered during enteroclysis in elderly patients. These arrhythmias may be attributed to the preexisting heart disease, fear, and anxiety during intubation, or increased sympathetic tone from the enteric loop distention.

From the *Departments of Radiology, SOTIRIA and NIMTS General Hospitals, Athens, Greece; the School of Health and Social Sciences, Patras Technological and Educational Institute, Patras, Greece, and the Department of Cardiology, Ioannina Medical School, Ioannina, Greece.

Reprint requests: Nicholas G. Kounis, MD, 7 Aratou Street, Queen Olga's Square, Patras 26221, Greece.

Received July 25, 1994, and accepted for publication, after revision, April 6, 1995.

© Lippincott-Raven Publishers