Upper gastrointestinal (GI) tract endoscopies are associated with a cardiovascular complication rate of 0.009% to 0.4%, which may be considered rare events. The endoscopy-associated lethality due to cardiovascular accidents ranges from 0.005% to 0.07%. Sinus tachycardia represents the most frequent cardiovascular finding, and vagolytic premedication often plays a causal role. Such accelerated heart rates may predispose to myocardial ischemia due to an augmented cardiac work load. Electrocardiographic alterations of the ST-T segment have been observed in 4% to 46% of upper GI tract endoscopy patients. Severe arrhythmias are rare phenomena. The cardiovascular risk of colonoscopy and laparoscopy appears to be even smaller as compared to gastroscopy. Advanced age, severe coronary heart disease and cor pulmonale may be useful indicants to identify a high risk patient subgroup.