Abstract
Myocardial infarction is a serious compiication during digestive endoscopy. decently, "takotsubo"type cardiomyophaty has been reported as mimic rnyocardial infarction, Weexperienced this type of cardiomyophaty during upper digestive endoscopy in a 74-year old woman and could observe changes of syrnptoms and signs at the onset under vital signmonitoring."Takotsubo"type cardiornyopahty has been defined as reversible left ventricledysfunction with ST elevation in some lead of EEG and reported that the reduced cardialfunction returns to normal within several weeks. Patients with eardiomyophaty are usuallymisdiagnosed as acutc myocardial infarction through EEG findings. The causes of"takotsubo"type cardiomyopahty are uncertain, but it is reported that there is more frequently in wornenwith more than 60 year of age, and it is assumed that stress is a major trigger fer the enset ofthis type cardiomyopahty. Stress such as esophagogastroduodenoscopy(EGD)induces anunstable autonomic nervous condition. wring END, sympathetic nerve are generally in tension, but parasympathetic nerve becometense only xn the early period of END. During inversion of the scope from the pharynx into theesophagus and from the lower esophagus to the cardia of the stomach, sympathetic nerves areusually activated, which induces tachycardia of the heart. In this case, however, insersion of thescope causes bradycardia, which indicates parasympathetic nerve activation. Unstable condition of autonomic nervous system caused by this stress might be a key role of onset of"takotsubo"type cardiomyopahty in this case. Because there is a risk of myoardial infarction or myoardial infarction-like state, as thistype cardiomyopahty in the case reported here, we recommended vital sign monitoring duringdigestive endoscopy.
