Reply to Dr. García-Cano

We appreciate the interest in our recent paper [1] by Dr. García-Cano. It would be worth commenting on whether there was echocardiographic evidence of preexisting impairment of left ventricular function and if there was a rise in troponin to suggest an acute ischaemic event. There is no mention of whether the patient was given intravenous fluids following endoscopic retrograde cholangiopancreatography (ERCP) or whether the rate of infusion might have been a contributing factor in precipitating pulmonary oedema. This case may suggest that a formal cardiovascular evaluation of patients with a previous cardiac history may be required before ERCP. It is reassuring to know that cardiopulmonary complications, such as this, are rare following ERCP in other institutions.

References

• 1 Johnston S D, McKenna A, Tham T CK. Silent myocardial ischaemia during endoscopic retrograde cholangiopancreatography.  Endoscopy. 2003;  35 1039-1042