Electrocardiographic abnormalities in patients with acute pancreatitis

Permanent pacemaker implantation for atrioventricular block secondary to acute pancreatitis in a patient affected by panhypopituitarism

BACKGROUND

Hypopituitarism may trigger the development of acute pancreatitis (AP) through multiple mechanisms. AP may alter normal intracardiac conduction leading to an atrioventricular block. Due to the lack of similar cases, the correct timing and indication for pacemaker implantation in such a setting are unknown.

CASE PRESENTATION

A 22-year-old woman with a history of sub-total excision of frontal astrocytoma with residual panhypopituitarism in replacement therapy was admitted to the emergency department with AP and peripancreatic necrosis, complicated by hypotension, sinus bradycardia with 2:1 atrioventricular block, and severe acute respiratory distress syndrome deserving intubation and mechanical ventilation. During the in-hospital course, the patient developed a systemic inflammatory response syndrome and acute kidney failure and was treated with intravenous dopamine, diuretics, and liquids. While she gradually recovered, advanced atrioventricular block persisted after the resolution of AP; therefore, a permanent pacemaker was implanted. During the follow-up, appropriate device interventions were detected.

CONCLUSIONS

No other cases of high-grade atrioventricular block in panhypopituitarism-induced AP have been reported in the literature. Our case suggests a pacemaker is necessary if the atrioventricular block does not recover with AP resolution. Further evidence is required to improve the management of rhythm disturbances in hypopituitarism patients who develop AP.

Assessment of frontal QRS-T angle in distinguishing mild and severe acute pancreatitis in emergency department: A retrospective study

Acute pancreatitis (AP) is a disease that poses significant health risks with potential severe outcomes. Identifying markers for severity can aid in early intervention and improve prognoses. This study, conducted in the emergency department, investigates the QRS-T angle as a potential indicator of severity in patients with acute pancreatitis. This retrospective study included 367 patients diagnosed with AP, classified as either mild acute pancreatitis or severe acute pancreatitis based on Ranson criteria. The QRS-T angle was measured using standard 12-lead electrocardiogram, and the data were analyzed to compare the QRS-T angles between the mild acute pancreatitis and severe acute pancreatitis groups. This research adhered to the guidelines outlined in the Strengthening the Reporting of Observational Studies in Epidemiology statement. The study included 367 patients, 94% (n = 345) had mild pancreatitis while 6% (n = 22) had severe pancreatitis. Severe cases had a significantly higher median age (P < .001) and higher rates of hypertension and diabetes mellitus (P = .027, P = .011). Severe cases also had higher Ranson scores (3 [IQR 3-3.25] vs 1 [IQR 1-2], P < .001) and longer hospital stays (6 [IQR 2.75-11.5] days vs 3 [2-5] days, P = .029). Additionally, severe pancreatitis group showed higher QRS-T angle (P < .001), higher rates of abnormal QRS angles (31.8% vs 10.1%, P = .002), and QRS-T angles (31.8% vs 8.1%, P < .001). The QRS-T angle may serve as a valuable clinical tool for differentiating between mild and severe forms of acute pancreatitis. This could potentially help clinicians in stratifying patients according to their risk and tailoring their management accordingly.

Assessment of early factors for identification or prediction severe acute pancreatitis in pregnancy

BACKGROUND

Acute pancreatitis in pregnancy (APIP) is a rare and serious condition, and severe APIP (SAPIP) can lead to pancreatic necrosis, abscess, multiple organ dysfunction, and other adverse maternal and infant outcomes. Therefore, early identification or prediction of SAPIP is important.

AIM

To assess factors for early identification or prediction of SAPIP.

METHODS

The clinical data of patients with APIP were retrospectively analyzed. Patients were classified with mild acute pancreatitis or severe acute pancreatitis, and the clinical characteristics and laboratory biochemical indexes were compared between the two groups. Logical regression and receiver operating characteristic curve analyses were performed to assess the efficacy of the factors for identification or prediction of SAPIP.

RESULTS

A total of 45 APIP patients were enrolled. Compared with the mild acute pancreatitis group, the severe acute pancreatitis group had significantly increased (P < 0.01) heart rate (HR), hemoglobin, neutrophil ratio (NEUT%), and neutrophil-lymphocyte ratio (NLR), while lymphocytes were significantly decreased (P < 0.01). Logical regression analysis showed that HR, NEUT%, NLR, and lymphocyte count differed significantly (P < 0.01) between the groups. These may be factors for early identification or prediction of SAPIP. The area under the curve of HR, NEUT%, NLR, and lymphocyte count in the receiver operating characteristic curve analysis was 0.748, 0.732, 0.821, and 0.774, respectively. The combined analysis showed that the area under the curve, sensitivity, and specificity were 0.869, 90.5%, and 70.8%, respectively.

CONCLUSION

HR, NEUT%, NLR, and lymphocyte count can be used for early identification or prediction of SAPIP, and the combination of the four factors is expected to improve identification or prediction of SAPIP.

Electrocardiogram Features in Non-Cardiac Diseases: From Mechanisms to Practical Aspects

Despite the noteworthy advancements and the introduction of new technologies in diagnostic tools for cardiovascular disorders, the electrocardiogram (ECG) remains a reliable, easily accessible, and affordable tool to use. In addition to its crucial role in cardiac emergencies, ECG can be considered a very useful ancillary tool for the diagnosis of many non-cardiac diseases as well. In this narrative review, we aimed to explore the potential contributions of ECG for the diagnosis of non-cardiac diseases such as stroke, migraine, pancreatitis, Kounis syndrome, hypothermia, esophageal disorders, pulmonary embolism, pulmonary diseases, electrolyte disturbances, anemia, coronavirus disease 2019, different intoxications and pregnancy.

Acute Pancreatitis Masquerading as Inferior Wall Myocardial Infarction: A Review

A rare presentation of acute pancreatitis is with electrocardiographic (ECG) changes that mimic myocardial ischemia. We present a report of a patient that presented with hemodynamic instability and new ECG changes of ST segment elevations in contiguous leads II, III, and aVF mimicking an inferior wall myocardial infarction. Emergent coronary angiography showed no significant coronary obstruction, but it was followed by a left-sided hemiplegia with radiographic evidence of diffuse embolic stroke. The patient was later found to have an underlying diagnosis of pancreatitis. Additional history that later became available indicated a history of severe acute pancreatitis treated elsewhere a few months prior to the current admission. We present the first comprehensive review of the literature comprising 36 total cases with pancreatitis masquerading as acute myocardial infarction, with inferior wall STEMI pattern being the most frequent. We present this case to highlight the diagnostic dilemma posed by this masquerade of a high acuity myocardial infarction and to highlight alternative diagnoses to be considered in such clinical circumstances.

Acute Pancreatitis Mimicking ST-Segment Elevation Myocardial Infarction

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.

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

BACKGROUND

Acute 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 PRESENTATION

A 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.

CONCLUSIONS

Nonspecific 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.

Prevalence of cardiovascular dysfunction and its association with outcome in patients with acute pancreatitis

BACKGROUND

Organ failure (OF) is the most important predictor of outcome in severe acute pancreatitis (SAP). Cardiovascular failure (CVSF) occurs in a variable proportion of patients with SAP. We aimed to study myocardial dysfunction in acute pancreatitis (AP) and its impact on the outcome.

METHODS

In this prospective study between January 2011 and July 2012, consecutive eligible patients of AP were enrolled. Myocardial function was assessed by measuring CK-MB (creatine phosphokinase isoenzyme) and echocardiography at admission. Electrocardiography (ECG) findings at admission were noted. Patients were managed in a high dependency unit using a step-up approach and followed up during hospital stay for their outcome. The outcome variables were computed tomography severity index (CTSI), the severity of AP, infection, need for intervention, length of hospital stay, and mortality.

RESULTS

Of the 65 patients (mean age 39.55 ± 13.14 years; 67.7% males; etiology: alcohol 47.7%, gallstone disease 43.1%, and others 3%), 28 (43%) had organ failure. Respiratory failure was present in 21 (32.3%) patients, acute kidney injury (AKI) in 11 (16.9%) patients, and cardiovascular dysfunction was present in 4 (6.2%) patients. ECG changes were present in 26 (40%) patients with ST segment depression with T wave inversion being the most common (n = 22, 85%). Elevated CK-MB level (more than two times normal) was seen in 18 (27.7%) patients and was associated with increased necrosis (odds ratio = 2.44, 95% confidence interval = 0.5-12.3, p = 0.021), CTSI (7.7 ± 2.7 vs. 5.0 ± 3.0, p = 0.002), severity of AP (p = 0.05), CVSF (p = 0.005), hospital stay (19.3 ± 12.3 vs. 12.3 ± 7.0, p = 0.006), and mortality (odds ratio = 6.42, 95% confidence interval = 1.0-38.9, p = 0.045). Left ventricular systolic dysfunction (left ventricular ejection fraction [LVEF] < 55%) was seen in 9 (13.8%) patients, all of whom had mild systolic dysfunction and left ventricular diastolic dysfunction (LVDD) was seen in 17 (26.2%) patients. There was no association between poor LVEF or LVDD and necrosis, severity of AP, infection, need for intervention, duration of hospital stay, and mortality.

CONCLUSION

Elevated CK-MB levels were associated with increased necrosis, higher CTSI, the severity of AP, cardiovascular failure, prolonged hospital stay, LVDD, and mortality. Echocardiographic findings namely left ventricular systolic and diastolic dysfunctions were not associated with severity or outcome of AP.

ST Segment Elevation with Normal Coronaries

Noncardiac causes should be kept in the differential while evaluating ST elevation on EKG. Rarely abdominal pathologies like acute pancreatitis can present with ST elevation in the inferior leads. Once acute coronary syndrome is ruled out by emergent cardiac catheterization alternative diagnosis should be sorted. Abdominal pathologies, like acute pancreatitis and acute cholecystitis, can present with ST elevation in the inferior leads. Treating the underlying condition would result in resolution of these EKG changes.

Acute cholecystitis mimicking or accompanying cardiovascular disease among Japanese patients hospitalized in a Cardiology Department

BACKGROUND

Acute cholecystitis sometimes displays symptoms and electrocardiographic changes mimicking cardiovascular problems. It may also coexist with cardiovascular disorders. We analyzed the clinical characteristic of the cardiac patients who were diagnosed with acute cholecystitis during hospitalization in the cardiology department.

METHODS

Using the department database, we identified 16 patients who were diagnosed with acute cholecystitis during the hospitalization in the cardiology department between June 2010 and June 2014.

RESULTS

Five patients who were initially suspected to have cardiac problems (acute coronary syndrome, four patients; Adams-Stokes syndrome, one patient) owing to their symptoms were subsequently diagnosed with acute cholecystitis. Two of these patients showed electrocardiographic changes mimicking myocardial ischemia, and three tested positive for a biomarker (heart-type fatty acid binding protein) of acute myocardial injury. The 11 remaining cardiac patients were diagnosed with acute cholecystitis during their hospitalization or at the time of admission. Prolonged fasting and/or staying in an intensive care unit (ICU) may have contributed to their condition. Among these 11 patients, aortic dissection was the most prevalent underlying cardiac condition, affecting 5 patients.

CONCLUSIONS

Although it is a rare condition, acute cholecystitis may coexist with or be misdiagnosed as a cardiovascular disorder. This possibility should not be overlooked in cardiac patients because a delay in treatment may result in critical complications.

Tempol, a Membrane-Permeable Radical Scavenger, Exhibits Anti-Inflammatory and Cardioprotective Effects in the Cerulein-Induced Pancreatitis Rat Model

To date, it remains unclear whether mild form of acute pancreatitis (AP) may cause myocardial damage which may be asymptomatic for a long time. Pathogenesis of AP-related cardiac injury may be attributed in part to ROS/RNS overproduction. The aim of the present study was to evaluate the oxidative stress changes in both the pancreas and the heart and to estimate the protective effects of 1-oxyl-2,2,6,6-tetramethyl-4-hydroxypiperidine (tempol) at the early phase of AP. Cerulein-induced AP led to the development of acute edematous pancreatitis with a significant decrease in the level of sulfhydryl (–SH) groups (oxidation marker) both in heart and in pancreatic tissues as well as a substantial increase in plasma creatine kinase isoenzyme (CK-MB) activity (marker of the heart muscle lesion) which confirmed the role of oxidative stress in the pathogenesis of cardiac damage. The tempol treatment significantly reduced the intensity of inflammation and oxidative damage and decreased the morphological evidence of pancreas injury at early AP stages. Moreover, it markedly attenuated AP-induced cardiac damage revealed by normalization of the –SH group levels and CK-MB activity. On the basis of these studies, it is possible to conclude that tempol has a profound protective effect against cardiac and pancreatic damage induced by AP.

Acute coronary syndrome mimicked by acute cholecystitis

Various aetiologies have been reported that cause severe trauma segment and T-wave abnormalities that are not related to acute coronary syndromes. However, the reports of transient ECG abnormalities associated with acute cholecystitis are limited in the literature. We describe a 42-year-old man presented with abdominal pain and hypertensive episode that developed dynamic ECG changes mimicking acute coronary syndrome and was diagnosed acute cholecystitis eventually. Emergency physicians should keep in mind dynamic T-wave changes mimicking acute myocardial ischaemia in patients with acute cholecystitis.

Diastolic dysfunction, prolonged QTc interval and pericardial effusion as predictors of mortality in acute pancreatitis

BACKGROUND AND AIM

The cardiac changes in acute pancreatitis have been earlier studied but the data on their prognostic significance is limited. This study was done to determine electrocardiographic (ECG) and echocardiographic changes in acute pancreatitis and determine their prognostic significance.

METHODS

Fifty-two consecutive patients (mean age 36.5 ± 11 years (44 males)) with acute pancreatitis and without prior cardiovascular comorbidites were prospectively enrolled and subjected to clinical, laboratory and radiological investigation. ECG and echocardiography was done at admission and during follow up.

RESULTS

Seventeen patients (32.7%) had mild pancreatitis and 35 (67.3%) patients had severe pancreatitis. Sinus tachycardia was the most common ECG abnormality. QTc prolongation was seen in 30/52 (57.7%) patients. On echocardiography, no patient had systolic dysfunction but 31/52 (59.6%) patients had diastolic dysfunction. All 22 patients with QTc interval < 440 ms survived compared with 8/30 patients with QTc interval ≥ 440 ms who died (P = 0.01). All eight patients who died had evidence of diastolic dysfunction (100%). None of the patients without diastolic dysfunction succumbed to illness (P = 0.02). Pericardial effusion was present in 6/52 (11.5%) patients. Of the eight patients who died, pericardial effusion was present in three (37.5%) patients and this frequency was significantly higher than that in patients who recovered (3/44 [6.8%]; P = 0.04).

CONCLUSION

Electrocardiographic and echocardiographic changes are seen in more than 50% of patients with acute pancreatitis. Prolonged QTc interval, pericardial effusion and diastolic dysfunction are associated with higher mortality.

Cardiovascular manifestations of acute pancreatitis

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas that is associated with variable involvement of pancreatic/peripancreatic tissue and one or more organ systems in varying degrees. Among the multiple organ system dysfunctions in severe AP, cardiovascular and/or pulmonary manifestations are frequent. The cardiovascular system may be affected alone or with other organ systems in all stages of AP. Abnormalities of cardiac rhythm, contractility, and vasomotor tone of peripheral vessels are common cardiovascular manifestations. The pathogenetic factors of cardiac manifestations include hypovolemia and metabolic disturbances (eg, hyperkalemia, hypomagnesemia, and hypophosphatemia). Clinically, patients present with hypotension, tachycardia, and signs of systemic inflammatory response syndrome (high cardiac index, significant pulmonary shunting, decreased systemic vascular resistance, and decreased myocardial contractility). Approximately 50% of patients with AP have electrocardiographic changes, most commonly T-wave flattening and ST-segment depression. Many of the cardiac manifestations in AP are reversible with appropriate management. In AP, early onset of either multi-organ dysfunction or a sustained single-organ dysfunction is associated with poor outcome. This review highlights cardiac manifestations of AP relevant to clinical practice.

Intermittent AV block conduction abnormalities in the setting of acute pancreatitis

A 56-year-old Caucasian male was admitted to our hospital with complaints of shortness of breath, joint aches, and chills in the absence of fever. During his hospitalization, he remained afebrile, but developed multiple episodes of bradycardia and intermittent second degree atrioventricular (AV) block, with both Wenckebach and Mobitz type II episodes. Laboratory evaluation demonstrated a chronically elevated amylase, without any significant electrolyte abnormalities. Abdominal computed tomography scan revealed prominence of the pancreatic head without any discrete pancreatic mass, suggestive of chronic pancreatitis. Pancreatic disorders, including acute pancreatitis or exacerbation of chronic pancreatitis, may be associated with intermittent transient AV block conduction abnormalities. Although the pathophysiology remains unclear, awareness of this entity is important for clinicians for appropriate management. Progression to more severe, permanent AV block necessitating permanent pacemaker implant to our knowledge has not been reported.

[Acute pancreatitis and bradycardia]

Acute pancreatitis is frequently associated with electrocardiographic abnormalities, including arrhythmias and repolarization. We briefly describe a male patient with a severe acute pancreatitis who presented several bradycardias during his hospitalization in our intensive care unit. The aim of this case report is to underline the probability of severe arrhythmias during acute pancreatitis, which can increase morbidity of this pathology. Despite many publications or reports, causes of increased EKG abnormalities during severe pancreatitis remained unclear and are probably multifactorial. To prevent accidents or complications, patients with severe acute pancreatitis should have a continuous EKG monitoring.

Perplexing epigastric pain-coincident myocardial infarction and acute pancreatitis

Acute myocardial infarction (MI) complicated with acute pancreatitis has been rarely reported. A 68-year-old man presented to our department 15 hours after development of epigastric pain. In addition to his symptoms, the elevated serum pancreatic enzymes and the image study on abdominal computerized tomography all led to the diagnosis of acute pancreatitis. Elevated cardiac biomarkers and a standard 12-lead electrocardiogram (ECG) demonstrating ST-segment elevation in 5 of the 6 precordial leads suggested an attack of MI. Oral intake was resumed after medical management for his acute pancreatitis and acute MI. Coronary angiogram on day 11 revealed total occlusion of the middle segment of the left anterior-descending coronary artery. Subsequently, angioplasty with stenting was done. The patient was discharged without significant complications. It is critical to make a rapid but detailed differential diagnosis of abdominal pain. Even though acute pancreatitis-associated ECG abnormalities have been reported previously, any ECG abnormalities in a patient presenting abdominal pain should be evaluated and treated cautiously. Thorough clinical evidence, including history, physical findings, ECG, image studies and serum biomarkers, are informative in seeking and analyzing possible etiologies.

Protective effects of Danhong injection against heart injury in rats with severe acute pancreatitis

AIM: To investigate the myocardial injury, the significance of intramyocardial genetic expression of bcl-2 and bax induced by severe acute pancreatitis in rats, and the effects of danhong injection on heart injury in rats with SAP.

METHODS: Seventy-two male SD rats were randomly divided into the control group (group A, n = 24), the SAP model group (group B, n = 24) and the danhong injection treatment group (group C, n = 24). Those in group B＆C received two injections of 3.2 g/kg body weight L-Arg i.p. at an interval of 1 h. Artery blood of the A, B, C groups was obtained at 6 h, 12 h and 18 h after induction of the model respectively. The serum concentrations of CK-MB and CTnI were detected respectively. The expression of bcl-2 gene and bax gene in myocardial tissue was detected using SABC immunohistochemical staining. And the myocardial tissues were examined under optical and electron microscope according to routine methods.

RESULTS: Compared with group A, the serum contents of CK-MB and CTnI in group B were significantly increased [CTnI (μg/L): 6 h: 2.18 ± 0.07 vs 0.19 ± 0.02, 12 h: 3.32 ± 0.31 vs 0.21 ± 0.05, 18 h: 3.81 ± 0.48 vs 0.20 ± 0.08, all P < 0.05; CK-MB (U/L): 6 h: 3028.8 ± 542.2 vs 178.0 ± 42.2, 12 h: 3511.7 ± 1172.2 vs 176.4 ± 39.8, 18 h: 4921.2 ± 1822.3 vs 185.2 ± 41.6, all P < 0.05]. Compared with group B, the serum contents of CK-MB and CTnI in group C were significantly decreased (all P < 0.05). Compared with group A, the expression of bax gene (PU) in group B was significantly increased (6 h: 4.58 ± 1.07 vs 1.10 ± 0.08, 12 h: 8.02 ± 0.31 vs 1.15 ± 0.09, 18 h: 8.81 ± 0.68 vs 1.20 ± 0.06, all P < 0.05). The ratio of bcl-2/bax was significantly decreased (6 h: 0.55 ± 0.11 vs 1.17 ± 0.07, 12 h: 0.33 ± 0.08 vs 1.23 ± 0.13, 18 h: 0.43 ± 0.15 vs 0.98 ± 0.19, all P < 0.05). Compared with group B, the expression of bax gene in group C was significantly decreased (all P < 0.05), and the expression of bcl-2 gene in group C was significantly increased (6 h: 3.15 ± 0.92 vs 1.25 ± 0.16, 12 h: 4.93 ± 0.52 vs 1.87 ± 0.20, 18 h: 4.63 ± 0.82 vs 3.41 ± 0.83, all P < 0.05). The ratio of bcl-2/bax was significantly increased (all P < 0.05). The pathological changes of myocardial tissues under optical and electron microscope in the group C were alleviated in contrast to the SAP group.

CONCLUSION: SAP may induce myocardial injury which might be related to the decreased expression of bcl-2 and the increased expression of bax gene. Danhong injection is an effective agent in attenuating the myocardial injury and its protective mechanism might be related to its effect on the increased expression of bcl-2 gene and the decreased expression of bax gene.

The protecting effects and mechanisms of Baicalin and Octreotide on heart injury in rats with SAP

Purpose. To observe the protecting effects and mechanisms of Baicalin and Octreotide on heart injury in rats with severe acute pancreatitis (SAP). Methods. The SAP rat models were randomly divided into the model group, Baicalin-treated group, Octreotide treated group, and sham operation group. The contents of some inflammatory indexes in blood were determined. The rat mortality, pathological changes of heart, the changes of NF-κB, P-Selectin, Bax, Bcl-2, and Caspase-3 protein expression levels as well as apoptotic index were observed in all groups, respectively, at 3 hours, 6 hours, and 12 hours after operation. Results. The survival rate of model group was less than treated groups at 12 hours, difference was significant. The contents of some inflammatory indexes of the treated groups were lower than those of the model group to various degrees at different time points. The pathological myocardial changes under light microscope were milder in treated groups than in model group. The changes of NF-κB, P-Selectin, Bax, Bcl-2, and Caspase-3 protein expression levels in all groups were different. There was only a case of myocardial cell apoptosis in an Octreotide-treated group at 6 hours. Conclusion. Baicalin and Octreotide have protecting effects on heart injury of rats with SAP.

Acute Pancreatitis Mimicking Acute Inferior Myocardial Infarction

A 56-year-old man presented with acute pancreatitis and electrocardiographic abnormalities, suggesting acute inferior myocardial infarction. An emergent coronary angiogram showed normal coronary arteries. The clinical significance and therapeutic implications of this rare finding are discussed.