ST Segment Elevation Pattern of Acute Myocardial Infarction Induced by Acute Pancreatitis

Abstract

The authors report the first emergent angiographic assessment of the coronaries with accompanying echocardiography in a 64-year-old man with dermatomyositis, who presented with ST segment elevation and cardiac specific enzyme derangements highly suggestive of myocardial infarction in the presence of acute pancreatitis. Both studies revealed no anatomical or functional evidence of obstructive coronary disease. Although the mechanism of electrocardiogram abnormalities found in acute pancreatitis remains to be elucidated fully, the authors propose a direct cardiac toxic effect by the pancreatic proteolytic enzymes to account for these changes and we recommend an angiographic approach as the first step to avoid the potentially lethal administration of thrombolytic therapy or potent anticoagulation.

T-wave depletion and bradycardia possibly secondary to acute pancreatitis: Review of the literature

“…In one case, a 64-year-old man proved to have normal coronary arteries (10). The possibility of CAD in our case is relatively low since she was healthy without any cardiovascular disease or risk factor, and the 201-Tl myocardial perfusion scintigraphy revealed no evidence of significant obstructive CAD.…”

“…pancreatitis has been documented in three cases (9,10). In one case, a 64-year-old man proved to have normal coronary arteries (10).…”

“…Various hypotheses have been formulated for the underlying mechanism of electrocardiography abnormalities and/or myocardial damage in acute pancreatitis (7)(8)(9)(10). These include toxic effects of the pancreatic proteolytic enzymes on the myocardium, autonomic imbalance with vagal predominance, coronary artery spasm, metabolic and electrolyte abnormalities, prothrombotic derangements, hemodynamic instability, and systemic inflammatory response-induced cardiac damage.…”

QT interval changes and reversibility of QT dispersion in patients with acute pancreatitis

“…Although the exact mechanism of cardiovascular changes remain topics of continued research, various hypotheses have been speculated for the underlying mechanism of electrocardiographic changes during the course of AP, including toxic effects of the pancreatic proteolytic enzymes such as myocardial depressant factor and kinins on the myocardium, autonomic imbalance with vagal predominance, coronary artery spasm, metabolic and electrolyte abnormalities, prothrombotic derangements, hemodynamic instability, and systemic inflammatory response-induced cardiac damage (22)(23)(24)(25).…”

Abnormal Cardiovascular Findings in Acute Pancreatitis: Are They Associated with Disease Severity?

“…Mechanisms such as myocardial ultrastructural disturbances 10 , release of pancreatic proteolytic enzymes 11 , hypovolemia, cytokines 4 , electrolyte disturbances 3,4 , and hemodynamic instability have been previously proposed 12 .…”