Acute Pancreatitis and Myocardial Infarction: A Narrative Review

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 infar ction 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 en zymes, 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 clini cians are aware that acute pancreatitis can mimic an acute myocardial infarction. Although we have started ...
Source: Cardiology - Category: Cardiology Source Type: research