ACUTE PANCREATITIS COMPLICATED BY ST-ELEVATION MYOCARDIAL INFARCTION

被引:7
|
作者
Phadke, Milind S.
Punjabi, Pritesh
Sharma, Sohan
Kide, Sandeep
Nawale, Jaywant
Chaurasia, Ajay
机构
[1] TN Med Coll & BYL Nair Ch Hosp, Dept Cardiol, Bombay, Maharashtra, India
[2] BYL Nair Charitable Hosp, Bombay, Maharashtra, India
来源
JOURNAL OF EMERGENCY MEDICINE | 2013年 / 44卷 / 05期
关键词
pancreatitis; myocardial infarction; ST-segment elevations; BROKEN HEART; THROMBOSIS;
D O I
10.1016/j.jemermed.2011.06.139
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Electrocardiographic abnormalities mimicking myocardial ischemia have been reported in intra-abdominal conditions, including acute pancreatitis. However, the occurrence of ST-elevation myocardial infarction (STEMI) is rare. Objectives: To present a case report of a young man with acute pancreatitis subsequently complicated by acute STEMI. The diagnosis and management of STEMI in acute pancreatitis can present unique diagnostic and therapeutic challenges, which are reviewed. Case Report: A 31-year-old man with no conventional coronary risk factors presented with acute abdominal pain, elevated pancreatic enzymes, and computed tomography scan findings of acute pancreatitis. The patient developed chest discomfort and presented to us on Day 2 with electrocardiographic evidence of an evolved extensive anterior wall myocardial infarction. Cardiac troponin I levels were elevated, and the electrocardiogram showed regional wall motion abnormalities in the left anterior descending territory (LAD). Coronary angiography done after stabilization showed a thrombus in the LAD, with no atherosclerotic lesions whatsoever. Hemostatic abnormalities are known in acute pancreatitis, and the development of a transient hypercoagulable state may be responsible for thrombotic complications. The overlap of some of the symptoms of the two conditions may cause diagnostic difficulty. Management issues include the choice of revascularization therapy, the safety of antiplatelet and anticoagulant therapy, intravenous fluid administration, and the use of cardiac medications that potentially can cause hypotension. Conclusion: The diagnosis and management of STEMI in the setting of acute pancreatitis can be challenging. In the absence of guidelines, a multidisciplinary approach individualized to the patient's clinical situation may be most appropriate. (C) 2013 Elsevier Inc.
引用
收藏
页码:932 / 935
页数:4
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