Acute pancreatitis mimicking myocardial infarction: potential for inadvertent use of thrombolytic therapy

Cardiac complications caused by biliary diseases: A review of clinical manifestations, pathogenesis and treatment strategies of cholecardia syndrome

Gallbladder and biliary diseases (GBDs) are one of the most common digestive diseases. The connections between GBDs and several organs other than the liver have gradually surfaced accompanied by the changes in people's diet structure and the continuous improvement of medical diagnosis technology. Among them, cholecardia syndrome that takes the heart as the important target of GBDs complications has been paid close attention. However, there are still no systematic report about its corresponding clinical manifestations and pathogenesis. This review summarized recent reported types of cholecardia syndrome and found that arrhythmia, myocardial injury, acute coronary syndrome and heart failure are common in the general population. Besides, the clinical diagnosis rate of intrahepatic cholestasis of pregnancy (ICP) and Alagille syndrome associated with gene mutation is also increasing. Accordingly, the underlying pathogenesis including abnormal secretion of bile acid, gene mutation, translocation and deletion (JAG1, NOTCH2, ABCG5/8 and CYP7A1), nerve reflex and autonomic neuropathy were further revealed. Finally, the potential treatment measures and clinical medication represented by ursodeoxycholic acid were summarized to provide assistance for clinical diagnosis and treatment.

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 myocardial infarction: evaluation with myocardial contrast echocardiography

Acute pancreatitis has frequently been reported to be associated with transient electrocardiography changes mimicking myocardial infarction despite normal epicardial coronary arteries. Although these reports generally have not included simultaneous assessment of myocardial function, 1 previous report has documented suggestive electrocardiography changes associated with a transient regional wall-motion abnormality but normal epicardial coronary arteries. Although the origin of these findings is poorly understood, suggested mechanisms have included electrolyte abnormalities, a vagally mediated reflex, coronary vasospasm, and myonecrosis as a result of the release of pancreatic proteolytic enzymes. We report a case of acute pancreatitis with electrocardiography changes and a regional wall-motion abnormality despite normal epicardial coronary arteries. Myocardial contrast echocardiography performed in this patient to evaluate the coronary microcirculation allows further insight into the mechanism of these findings.