Performance of barium examinations after acute myocardial infarction: report of a survey.

Abstract

A survey of members of the Society of Gastrointestinal Radiologists was conducted to ascertain the standards of practice and timing for elective barium studies of the gastrointestinal tract in patients recovering from acute myocardial infarction. Sixty-two percent of respondents do not have cardiac monitoring apparatus readily available in the fluoroscopy suite. When readily available, such equipment is rarely (42%) or never (58%) used during routine barium examinations. Twenty-four percent of respondents take special precautions when performing examinations on these patients by reducing patient movement, the length of the examination, and the number of radiographs exposed, and by employing cardiac monitoring. Seventy-two (89%) of 81 respondents noted at least one adverse cardiovascular reaction. This was most often chest pain, but there were 10 deaths from cardiac causes. Two-thirds of respondents delay elective barium examinations of any kind for at least 4 weeks after acute myocardial infarction. The remaining one-third perform these studies earlier than 4 weeks. The latter typically limit their studies to the upper gastrointestinal tract (82%), 42% of which are single-contrast; the rest are equally divided between double-contrast and biphasic studies. This minority of radiologists is twice as likely to perform a single-contrast barium enema than a double-contrast barium enema during this period. No such preference for single-contrast (47%) over double-contrast (53%) barium enema is revealed by the majority who delay their elective barium enemas 4 or more weeks. The data indicate a strong preference to defer elective barium examinations a minimum of 4 weeks after acute myocardial infarction. A sizable minority (one-third) of radiologists, however, feel comfortable performing a single-contrast upper gastrointestinal examination at an earlier time.