Long Yunxiang, Tang Manyun, Wang Jie, Liu Hui, Jian Zhijie, Li Guoliang, Liu Chang
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Front Cardiovasc Med. 2021 Dec 23;8:741253. doi: 10.3389/fcvm.2021.741253. eCollection 2021.
Both acute pancreatitis and acute myocardial infarction (AMI) are rapidly progressive and frequently fatal diseases that can be interrelated and lead to a vicious cycle for further problems. The concomitant occurrence of AMI and acute pancreatitis is rare but critical, and efficient diagnosis and treatment of such patients are challenging. We reported an uncommon case of abnormal ECG findings in a 63-year-old woman with acute pancreatitis. The patient exhibited increased biomarkers of myocardial injury, such as creatine kinase-MB (CK-MB) and troponin T, as well as ST segment elevation in inferior leads II, III, and aVF. Both of these have been previously observed in patients with acute abdomen in the absence of ST-segment elevation myocardial infarction (STEMI), including pancreatitis. In addition, lacking complaints of chest pain or tightness was also supportive of this idea. Echocardiography indicated abnormalities in the functioning of the left inferior posterior wall segments and decreased overall systolic function of the left ventricle with a 51% ejection fraction. Eventually, AMI was diagnosed after coronary computed tomography angiography (CCTA) showing critical stenosis of the right coronary artery and left anterior descending artery segments. The patient was urgently transferred to intensive care unit and was treated with anticoagulation, antiplatelet aggregation, lipid-lowering and other palliative drugs. Concomitant acute pancreatitis and AMI are often considered to be critical conditions with a poor prognosis. Therefore, it is important to rapidly identify this condition and consider transferring patients for multidisciplinary supportive care.
急性胰腺炎和急性心肌梗死（AMI）都是进展迅速且常致命的疾病，二者可能相互关联并导致进一步问题的恶性循环。AMI与急性胰腺炎同时发生的情况罕见但很关键，对这类患者进行有效的诊断和治疗具有挑战性。我们报告了一例63岁急性胰腺炎女性患者出现异常心电图表现的不寻常病例。该患者心肌损伤生物标志物升高，如肌酸激酶同工酶（CK-MB）和肌钙蛋白T，同时下壁导联II、III和aVF出现ST段抬高。此前在包括胰腺炎在内的无ST段抬高型心肌梗死（STEMI）的急腹症患者中也曾观察到这两种情况。此外，患者缺乏胸痛或胸闷主诉也支持这一观点。超声心动图显示左室下后壁节段功能异常，左室整体收缩功能下降，射血分数为51%。最终，冠状动脉计算机断层扫描血管造影（CCTA）显示右冠状动脉和左前降支节段严重狭窄，诊断为AMI。患者被紧急转入重症监护病房，接受抗凝、抗血小板聚集、降脂等姑息性药物治疗。急性胰腺炎和AMI同时发生通常被认为是预后不良的危急情况。因此，迅速识别这种情况并考虑将患者转至多学科支持治疗非常重要。
