A case of acute necrotizing pancreatitis complicated with non ST elevation myocardial infarction

Abstract

BackgroundAcute pancreatitis is an inflammatory condition with varying severity and a range of local and systemic complications. Here we report a patient with acute necrotizing pancreatitis complicated with a true non ST elevation myocardial infarction.Case presentationA 58 year old lady was admitted to our unit with acute onset epigastric pain and vomiting for 4 h duration. Following admission she complained of retrosternal tightening type of a chest pain. She had elevated serum amylase and cardiac troponin. Electrocardiogram (ECG) revealed lateral ischaemia. Contrast computerized tomography abdomen revealed acute severe necrotizing pancreatitis.ConclusionsNonspecific ECG changes can occur in patients with acute pancreatitis. But the diagnosis of true myocardial infarction in a context of acute pancreatitis using ECGs, 2D echocardiography, cardiac biomarkers and coronary angiograms can be challenging with the choice of revascularization therapy and safety of antiplatelet agents and anticoagulant therapy. Decision making regarding the management of such a patient is also critical.

Severe hypocalcemia mimicking acute inferior ST-segment elevation myocardial infarction

“…Acute pancreatitis of itself has been reported in the literature as a very rare cause of myocardial infarct pattern on EKG [ 16 ]. Some of the hypothesized relationships between acute pancreatitis and infarct EKG changes are: metabolic and electrolyte derangements, direct toxic effects on the myocardium, coronary artery vasospasm, and prothrombotic and inflammatory states [ 17 – 20 ].…”

Acute Pancreatitis Simulating Myocardial Infarction: A Challenging Case

“…Echocardiography can be performed in stress cardiomyopathy with elevated cardiac markers. When there is a high risk of acute coronary syndrome, coronary angiography can also be advised after evaluating the risk, benefits, and need for antithrombotic use [11][12][13][14]. In certain cases, conservative management with lipid-lowering drugs and antithrombotics may be advised, as acute pancreatitis is an absolute contraindication to coronary intervention [6].…”