Acute pancreatitis complicated by acute myocardial infarction – A rare association

Kumar, Akhilesh; Reddy, G. Mohan; Kumar, Ameet

doi:10.1016/j.ihj.2013.06.009

Cited by 20 publications

(22 citation statements)

References 10 publications

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“…Acute coronary syndrome was a rare event in our cohort (1.8%, 3/163), which is in keeping with several published case reports [ 28–31 ]. The incidence is lower than in similarly morbid conditions such as sepsis, where the incidence has been reported as 4.1% [ 32 , 33 ].…”

Section: Discussionsupporting

confidence: 92%

Extra-pancreatic complications, especially hemodialysis predict mortality and length of stay, in ICU patients admitted with acute pancreatitis

Kothari

Struyvenberg

Perillo

et al. 2018

Gastroenterology Report

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Background and aimsPatients in the intensive care unit (ICU) with acute pancreatitis (AP) are at risk for extra-pancreatic complications given their severe illness and prolonged length of stay. We sought to determine the rate of extra-pancreatic complications and its effect on length of stay (LOS) and mortality in ICU patients with AP.MethodsWe performed a retrospective cohort study of ICU patients admitted to a tertiary-care center with a diagnosis of AP. A total of 287 ICU patients had a discharge diagnosis of AP, of which 163 met inclusion criteria. We calculated incidence rates of extra-pancreatic complications and performed a univariate and multi-variable analysis to determine predictors of LOS and mortality.ResultsThere were a total of 158 extra-pancreatic complications (0.97 extra-pancreatic complications per patient). Ninety-five patients had at least one extra-pancreatic complication, whereas 68 patients had no extra-pancreatic complications. Patients with extra-pancreatic complications had a significantly longer LOS (14.7 vs 8.8 days, p < 0.01) when controlling for local pancreatic complications. Patients with non-infectious extra-pancreatic complications had a higher rate of mortality (24.0% vs 16.2%, p = 0.04). Patients requiring dialysis was an independent predictor for LOS and mortality (incidence risk ratio [IRR] 1.73, 95% confidence interval [CI]: 1.263–2.378 and IRR 1.50, 95% CI 1.623–6.843, p < 0.01) on multi-variable analysis. Coronary events were also a predictor for mortality (p = 0.05). Other extra-pancreatic complications were not significant.ConclusionsExtra-pancreatic complications occur frequently in ICU patients with AP and impact LOS. Patients with non-infectious extra-pancreatic complications have a higher mortality rate. After controlling for local pancreatic complications, patients requiring dialysis remained an independent predictor for LOS and mortality.

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Section: Discussionsupporting

confidence: 92%

Extra-pancreatic complications, especially hemodialysis predict mortality and length of stay, in ICU patients admitted with acute pancreatitis

Kothari

Struyvenberg

Perillo

et al. 2018

Gastroenterology Report

View full text Add to dashboard Cite

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“…The following hypotheses have been proposed to explain these ST-segment abnormalities in ECG: (1) Hypovolemia and hypotension can cause coronary hypoperfusion especially in patients with significant coronary artery disease [ 10 ]. (2) Electrolyte abnormalities such as hypokalemia, hypomagnesemia, hypocalcemia, and hyponatremia can modify the repolarization phase on ECG [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Pancreatitis Mimicking ST-Segment Elevation Myocardial Infarction

Agrawal

Sayyida

Peñalver

et al. 2018

Case Reports in Cardiology

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Introduction Electrocardiographic changes imitating myocardial ischemia have been occasionally reported in patients with intra-abdominal pathology including acute pancreatitis. Case Report A 60-year-old man with no past medical history presented to the emergency department (ED) after a syncopal episode. In ED, his vitals were stable. His ECG showed sinus bradycardia at 53 beats per minute, peaked T waves, 1 mm ST-segment elevation in leads II, III, and aVF, and 2 mm ST elevation in V3 as shown in the figures. With the concern for STEMI, he was taken for left heart catheterization (LHC) emergently, showing nonobstructive coronary artery disease (CAD). His laboratory workup was remarkable for lipase of 25,304 IU/l (normal level 8–78 IU/l). His liver function test and triglyceride level were normal. Troponin was <0.01 ng/ml. A computed tomographic exam of the abdomen revealed acute interstitial pancreatitis with a small discrete fluid collection in the uncinate process. He was treated with aggressive intravenous fluid resuscitation and was discharged on day 3. Discussion Intra-abdominal pathologies like acute pancreatitis can lead to transient ECG changes mimicking STEMI. It is important to use ECG clues, echocardiographic findings, and clinical judgement to avoid cardiac catheterization, contrast exposure, and associated health care costs.

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“…Acute pancreatitis associated with true myocardial infarction is a rare incident and Kumara et al [ 8 ] have reported such a true ST elevation myocardial infarction in a young patient with acute pancreatitis. In 2005, Krantzopoulos et al [ 9 ] also have reported another case of myocardial infarction with acute pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

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

2018

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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.

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Acute pancreatitis complicated by acute myocardial infarction – A rare association

Cited by 20 publications

References 10 publications

Extra-pancreatic complications, especially hemodialysis predict mortality and length of stay, in ICU patients admitted with acute pancreatitis

Extra-pancreatic complications, especially hemodialysis predict mortality and length of stay, in ICU patients admitted with acute pancreatitis

Acute Pancreatitis Mimicking ST-Segment Elevation Myocardial Infarction

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

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