Objective To determine the safety of transnasal endoscopy for the elderly with coronary heart diseases (CHD). Methods A prospective study was carried out in 100 over-65-year-old patients undergoing gastroscopy in our department from January to December 2012. They were randomly and equally divided into conventional gastroscopy group (n＝50) and transnasal endoscopy group (n＝50), and then, every group was further divided into CHD subgroup (n＝25) and control subgroup (without heart diseases, n＝25). The heart rate, blood pressure, arterial oxygen saturation, myocardial oxygen consumption and electrocardiogram during performance of endoscopy were compared between groups. Results During conventional gastroscopy, the increases of heart rate, blood pressure, and myocardial oxygen consumption, and the decrease of arterial oxygen saturation were significantly more obvious in CHD subgroup than the corresponding control subgroup (P＜0.05). And, the incidences of arrhythmia and ST segment depression were higher in CHD subgroup than in control subgroup (P＜0.05). For those receiving transnasal endoscopy, CHD patients had significantly mild increases in heart rate, blood pressure, and myocardial oxygen consumption, lower arterial oxygen saturation, and decreased incidences of arrhythmia and ST segment depression than the CHD patients undergoing conventional gastroscopy (P＜0.05). Conclusion Transnasal endoscopy is well tolerated to elderly patients with CHD, and has fewer hemodynamic effects and higher safety.