Background Acute pancreatitis can rarely present with electrocardiographic changes that imitate myocardial ischemia. Even rarer is for acute pancreatitis to present with ST-segment elevation in contiguous leads, suggestive of an acute coronary syndrome. In this comprehensive review article, we highlight diagnostic challenges and examine possible pathophysiological causes as seen through 34 total cases in which acute pancreatitis has been found to mimic an acute myocardial infarction. Summary It has been shown that regardless of the severity of acute pancreatitis, it can be associated with myocardial injury of varying presentation. Thus far, there have been 34 total cases where acute pancreatitis presented with electrocardiographic changes consistent with acute myocardial infarction without true coronary artery thrombosis. An inferior wall ST-elevation myocardial infarction pattern was the most frequently demonstrated. Many hypotheses have been proposed as to the mechanism of injury including decreased coronary perfusion, direct myocyte damage by pancreatic proteolytic enzymes, indirect parasympathetic injury, electrolyte derangements, and coronary vasospasms. Given the complexity of the clinical presentation, thorough subjective and objective evaluation can be vital in guiding diagnosis and possibly more invasive testing. Key Messages It is imperative that clinicians are aware that acute pancreatitis can mimic an acute myocardial infarction. Although we have started to better understand the pathological mechanisms for this phenomenon, further research focused on specific molecular target areas is needed.
Background: Despite advances in representation of women in medical training, women continue to be underrepresented in cardiology, particularly in senior roles of authorship and leadership. Analyzing trends in high-impact cardiology journals can highlight underrepresentation of women and help elucidate barriers to female representation in academic cardiology. Methods and Results: Using the SCImago Journal and Country Rank (SCR), we analyzed 20 journals (31,540 total articles) in cardiology and cardiovascular medicine with the highest total citations from January 1 st 2018 to October 31 st 2021 for gender distribution of editorial staff and authorship. Gender of individuals was classified using biographical information from public and personal media sources. In cases of ambiguity, Genderize.io was used to help predict gender at probability of ≥95%. Our data demonstrated that 27% of articles had women as first authors and 20% as senior authors. Men constituted the majority of both first authors (73%) and senior authors (80%). The editorial staff was 77% men, with women accounting for 23%. Only 10% of editors-in-chief were women. There was a statistically significant negative correlation between the percentage of women first authors and percentage of men on the editorial board. There was no statistical significance between journal impact factor and percentage of men and women as authors. Overall, female authorship increased from 26% first and 19% senior authors in 2018 to 29% first and 22% senior authors in 2021. Conclusion: Women are significantly under-represented in the field of cardiology as first or senior authors, editorial board members, and editors-in-chief in the top medical journals. Although there has been a slight uptrend in percentage of women occupying leading publishing roles, parity with men is still a work in progress. Additional work is needed to identify and address barriers to publishing and academic advancement for women physicians in cardiology.
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