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e a and b: CT scan of the abdomen showing evidence of acute pancreatitis.
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Acute pancreatitis complicated by acute myocardial infarction has been reported very rarely. The exact mechanism of the cause of myocardial injury is not known. We report a case of 36 year old male presenting with acute pancreatitis complicated by ST elevation acute myocardial infarction (AMI). The administration of thrombolytic therapy in such pat...
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... with bilateral basal crepitations. ECG showed ( Figs. 1 and 2), ST elevation in leads V1 to V4 and 2DEcho showed regional wall motion abnormality in LAD territory with LV dysfunction. Biochemical investigations showed, serum CKNAC 826U/L, CKMB 50U/L, serum amylase 584 U/L and serum lipase 370 U/L. Ultrasound abdomen and CT scan abdomen ( Fig. 3a and b) showed signs of acute ...
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A 39-year-old primigravida woman at 33 + 4 weeks' dichorionic diamniotic gestation presented with severe bilateral lower-limb oedema a...
Background /Aim: Acute pancreatitis (AP) is a complex disease with various etiology, most frequent biliary and alcoholic. Clinical presentation shows different degree of severity with biphasic evolution. The aim of this study is to evaluate the surgical procedures with mini-invasive approach as preferred choice in patients with pancreatitis.
![Figure 3. Prevalence of elevated lipase values after azathioprine [AZA]...](profile/Bernd-Bokemeyer/publication/282873657/figure/fig3/AS:614153383333910@1523436985790/Prevalence-of-elevated-lipase-values-after-azathioprine-AZA-induction-ahead-of-acute_Q320.jpg)
Background and aims:
Azathioprine (AZA) is recommended for maintenance of steroid-free remission in IBD. The aim of this study has been to establish the incidence and severity of AZA-induced pancreatitis, an idiosyncratic and major side effect, and to identify specific risk factors.
Methods:
We studied 510 IBD patients (338 Crohn's disease, 157...
Citations
... Commonly observed manifestations include arrhythmias, cardiogenic shock, and myocarditis. [4][5][6] The pathogenesis of SAP-associated acute cardiac injury (SACI) is notably intricate, and a comprehensive understanding of its pathogenesis is still insufficient. The current understanding of the pathophysiological mechanism of SACI draws parallels with sepsis-induced cardiomyopathy (SICM), indicating that the structural damage and dysfunction of the heart are linked to heightened levels of risk factors such as trypsin, inflammation-related factors, reactive oxygen species (ROS), and endotoxins. ...
Severe acute pancreatitis (SAP) often develops into acute cardiac injury (ACI), contributing to the high mortality of SAP. Urolithin A (UA; 3,8‐dihydroxy‐6H‐dibenzopyran‐6‐one), a natural polyphenolic compound, has been extensively studied and shown to possess significant anti‐inflammatory effects. Nevertheless, the specific effects of UA in SAP‐associated acute cardiac injury (SACI) have not been definitively elucidated. Here, we investigated the therapeutic role and mechanisms of UA in SACI using transcriptomics and untargeted metabolomics analyses in a mouse model of SACI and in vitro studies. SACI resulted in severely damaged pancreatic and cardiac tissues with myocardial mitochondrial dysfunction and mitochondrial metabolism disorders. UA significantly reduced the levels of lipase, amylase and inflammatory factors, attenuated pathological damage to pancreatic and cardiac tissues, and reduced myocardial cell apoptosis and oxidative stress in SACI. Moreover, UA increased mitochondrial membrane potential and adenosine triphosphate production and restored mitochondrial metabolism, but the efficacy of UA was weakened by the inhibition of CPT1. Therefore, UA can attenuate cardiac mitochondrial dysfunction and reduce myocardial apoptosis by restoring the balance of mitochondrial fatty acid oxidation metabolism. CPT1 may be a potential target. This study has substantial implications for advancing our understanding of the pathogenesis and drug development of SACI.
... The literature review shows multiple case reports and review articles on ECG changes in AP; however, coronary angiogram was done in a few cases [7][8][9][10]. There are cases reported in the literature in which AP and ACS were found simultaneously [11][12][13]. Table 2 summarizes AP's clinical presentations with cardiac symptoms and outcomes [9,14]. Overall, 19 cases of AP with signs of acute myocardial infarction (AMI) were reviewed. ...
Acute pancreatitis (AP) refers to the acute inflammation of the pancreas; however, if there is concurrent necrosis, it is called necrotizing acute pancreatitis (NAP). The diagnosis is sometimes difficult because it might mimic acute coronary syndrome (ACS). We report a case of a 28-year-old male, who presented to the emergency department (ED) with severe epigastric pain, shortness of breath and diaphoresis for 4-5 h. The initial electrocardiogram (ECG) showed marked sinus bradycardia with an incomplete left bundle branch block. Considering the clinical presentation and ECG changes, he was managed as ACS and was rushed to catheterization laboratory for a coronary angiogram, which was reported normal. Subsequently, his serum pancreatic enzymes were elevated, and computed tomography of the abdomen showed NAP. In ED settings, it is difficult to differentiate between the two, particularly when AP presents with ECG manifestations masquerading as ACS.
... Coronary and/or arterial atherosclerosis are major risk factors for coronary heart disease and ischemic stroke, and are responsible for most of the cardiovascular mortality. Some studies have suggested that patients with acute or chronic pancreatitis have a higher incidence of acute atherosclerotic cardiovascular disease, including acute myocardial infarction and stroke, than patients without pancreatitis [10][11][12][13][14]. ...
Objectives: To analyze the incidence, prognosis, risk factors and diagnostic indicatorsof postoperative acute pancreatitis (PAP) in cases of acute type A aortic dissection (ATAAD).
Methods: We enrolled 639 patients with ATAAD who underwent thoracic aortic endovascular repair or open surgery at our center from January 2019 to October 2021, and reported the perioperative information. Once patients were diagnosed with PAP, we recorded the diagnostic features, including acute severe epigastric abdominal pain, pancreatic enzyme levels, and abdominal computed tomography or ultrasonography results.
Results: PAP in cases of ATAAD was present in 13 patients (13/639, 2.04%), who had a higher proportion of postoperative complications and worse prognosis. The incidences of postoperative hypoxemia [12 (92.31%) vs. 196 (31.31%)], low cardiac output syndrome [2 (15.38%) vs. 13 (2.08%)], need for renal-replacement therapy (RRT) [7 (53.85%) vs. 116 (18.53%)], pneumonia [8 (61.54%) vs. 80 (12.78%)], and bacteremia [5 (38.46%) vs. 27 (4.31%)] were higher in patients with PAP than in the control group. The 90-day mortality of postoperative PAP was 30.77% (4/13). Logistic regression analysis identified coronary and/or atherosclerosis (OR: 7.768, 95%CI [1.463- 41.261], p=0.016), postoperative hypoxemia (OR: 24.429, 95%CI[2.003-298.008, p=0.012), low cardiac output syndrome (OR: 27.382, 95%CI [1.65-454.271, p=0.021), and lactate dehydrogenase level (OR: 1.021, 95%CI [1.005- 1.037], p=0.01) as significant independent risk factors for PAP. Severe epigastric pain is the main manifestation of PAP in ATAAD patients.
Conclusions: PAP is a serious complication of ATAAD and is associated with poorer outcomes. Coronary and/or atherosclerosis, postoperative hypoxemia, low cardiac output syndrome, and higher lactate dehydrogenase levels are risk factors for PAP. In cases of progressively elevated pancreatic enzymes or positive abdominal symptoms, a computed tomography scan or magnetic resonance imaging should be performed immediately to rule out PAP.
... Although rare, cardiovascular complications can also occur in patients with acute pancreatitis, which include hypovolemia, pericardial effusion, shock or worsening of underlying ischemic heart disease, or heart failure [4]. Rarely acute pancreatitis can also be associated with many EKG changes, including arrhythmias and changes in T wave and ST-segment elevation mimicking myocardial infarction, which is not widely reported in the literature [5][6][7][8][9][10]. We have tabulated acute pancreatitis-induced cardiovascular complications in Table 2 The pathophysiology of acute pancreatitis-induced MI is complex and not fully understood. ...
Acute pancreatitis is an inflammatory condition with varying local and systemic complications and variable severity. Although rare, cardiovascular complications induced by acute pancreatitis are rarely described in the literature. Epigastric pain with acute pancreatitis often simulates electrocardiographic changes in the absence of coronary artery abnormalities, resulting in a diagnostic dilemma for optimal treatment and management. We underline a case of acute pancreatitis complicated by acute coronary syndrome in a patient who presented with chest heaviness, dyspnea, nausea, and worsening epigastric pain associated with vomiting. Clinical and laboratory evaluations and using imaging modalities were suggestive of acute pancreatitis mimicking myocardial infarction (MI) in the absence of coronary artery abnormalities.
... The exact mechanism of myocardial injury in acute pancreatitis is not known but several hypotheses have been proposed. Severe pancreatitis can cause severe hypotension, which can decrease coronary perfusion and lead to myocardial ischemia, especially in patients with coronary artery disease [11]. Pancreatic proteolytic enzymes (i.e., trypsin, etc.) may lead to cellular necrosis as well as electrolyte disturbance by directly damaging the membrane of the myocyte [12]. ...
... Culprit vessel(s) with significant stenosis are treated with revascularization. If thrombus is present, aspiration via catheter followed by plain old balloon angioplasty can be done [11]. As acute pancreatitis is an absolute contraindication to emergent percutaneous coronary intervention, conservative treatment with antithrombotic and lipid-lowering drugs can be chosen in certain scenarios [99]. ...
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 infarction 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 enzymes, 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 clinicians are aware that acute pancreatitis can mimic an acute myocardial infarction. Although we have started to better understand the pathological mechanisms for this phenomenon, further research focused on specific molecular target areas is needed.
... 9 It has been shown that, together with known major cardiovascular (CV) risk factors like smoking and hypertension, pancreatic exocrine insufficiency is significantly associated with the risk of CVevents in patients with CP. 10 In addition, although hypertension, obesity, dyslipidemia, diabetes mellitus (DM), smoking, excessive alcohol consumption, significant family history, and decreased physical activity are risk factors for coronary artery disease, 11 chronic inflammation has also been proven to be a well-established cause for developing atherosclerosis. 12 Previous studies have reported the incidence of acute atherosclerotic cardiovascular disease (ASCVD) in acute pancreatitis, 13,14 and a recent nationwide cohort study from Taiwan concluded that there was an increased risk of ASCVD in patients with CP, particularly those who had alcohol-related illness (hazard ratio [HR], 9.49; 95% confidence interval [CI], 3.78-23.8), liver cirrhosis (HR, 7.31; 95% CI, 1.81-29.5), ...
Objectives:
Worldwide prevalence of chronic pancreatitis (CP) has risen in recent years, with data suggesting an increased risk of atherosclerotic cardiovascular disease (ASCVD) in these patients. We assessed the incidence and risk of ASCVD in patients with CP.
Methods:
We compared the risk of ischemic heart disease, cerebrovascular accident, and peripheral arterial disease between CP and non-CP cohorts after propensity matching of known risk factors of ASCVD using TriNetX, a multi-institutional database. We also evaluated the risk of outcomes of ischemic heart disease including acute coronary syndrome, heart failure, cardiac arrest, and all-cause mortality between CP and non-CP cohorts.
Results:
Chronic pancreatitis cohort was also found to have an increased risk of ischemic heart disease (adjusted odds ratio [aOR], 1.08; 95% confidence interval [CI], 1.03-1.12), cerebrovascular accident (aOR, 1.12; 95% CI, 1.05-1.20), and peripheral arterial disease (aOR, 1.17; 95% CI, 1.1-1.24). Chronic pancreatitis patients with ischemic heart disease were also found to have an increased risk of acute coronary syndrome (aOR, 1.16; 95% CI, 1.04-1.30), cardiac arrest (aOR, 1.24; 95% CI, 1.01-1.53), and mortality (aOR, 1.60; 95% CI, 1.45-1.77).
Conclusions:
Chronic pancreatitis patients are at a higher risk of ASCVD when compared with the general population, matched for confounding etiological, pharmacological, and comorbid variables.
... Acute pancreatitis (AP) is a chronic fibrosis and inflammation of the pancreas causing functional abnormalities and irreversible morphological changes [1]. The advanced diagnostic modalities and increased alcohol consumption are the attributable factors for increased incidence of acute pancreatitis worldwide [2,3]. Chronic diarrhea, weight loss, maldigestion, incessant abdominal pain, and glucose intolerance were the symptoms of acute pancreatitis which lead to significant impacts on life quality [4]. ...
Background and Aim: Acute pancreatitis is a rapid progressive abdominal inflammatory disease with acute onset in clinics which turns into severe acute pancreatitis. In approximately 20% of patients characterized by different parameters such as gland flaky necrosis, multiple organ dysfunction syndrome (MODS), inflammatory cell infiltration in large number, and hemorrhage. Electrocardiography and electromyography variations are the common cardiac failure in patients with acute pancreatitis. Elevated cardiac enzymes could be other factors for cardiac failure with acute pancreatitis. The present study aimed to assess the prevalence of cardiovascular dysfunction and its association in patients with acute pancreatitis. Methodology: This cross-sectional study was carried out on 120 acute appendicitis patients in the department of Gastroenterology at Northwest General Hospital & Research Centre, Hayatabad Peshawar for the duration of six months from June 2021 to November 2021. All the patients who met the inclusion criteria were enrolled. Echocardiography and CK-MB (creatine phosphokinase isoenzyme) was measured for evaluating myocardial function after admission. All the patients underwent physical, clinical, and laboratory examination. The findings of Electrocardiography (ECG) were recorded. Acute appendicitis severity, duration of hospital stay, infection, computed tomography severity index (CTSI), and mortality were different outcomes. Results: Of the total 120 patients, about 83 (69.2%) were males and 37 (30.8%) were females. The overall mean age was 37.84±12.46 years. Out of 120 acute pancreatitis patients, the prevalence of gallstone disease, organic failure, respiratory failure, acute kidney failure, and cardiovascular dysfunction was 51 (43.3%), 47 (39.2%), 37 (30.8%), 19 (15.8%), and 9 (7.5%) respectively. Elevated CK-MB and ECG changes were seen in 32 (26.7%) and 42 (35%) respectively. The ECG variations and elevated CK-MB were related with severity of acute pancreatitis (p<0.05), duration of hospital (OR: 18.9 ± 10.6 vs. 11.7 ± 6.8, p = 0.005), CTSI (6.9 ± 3.1 vs. 4.7 ± 2.9, p = 0.001), increased necrosis (2.34, 95%CI= 0.3-11.8, p=0.011), and mortality (OR= 5.46, 95% CI= 1.2-34.9, p=0.05). The incidence of Left ventricular systolic dysfunction (LVEF) and left ventricular diastolic dysfunction (LVDD) was 15 (12.5%) and 31 (25.8%) respectively. Conclusion: The present study found that elevated CK-MB were significantly associated with higher CTSI, Prolonged hospital stay, severity of acute pancreatitis, LVDD, increased necrosis, and mortality. CK-MB increased levels have been reported as an indicator for cardiac failure and acute pancreatitis. There was a significant association between increased CK-MB levels and cardiovascular organ failure, pancreatic necrosis, and left ventricular diastolic dysfunction. Keywords: Cardiovascular dysfunction, Acute pancreatitis, Outcomes
... In most areas, the gallstone is the most common etiology following by idiopathic etiology. Acute pancreatitis is associated with profound hypotension, hyperglycemia and increased circulating levels of inflammatory cytokines/proteolytic enzymes 7,8 . Chronic pancreatitis is a chronic inflammatory and fibrotic disease of the pancreas with a prevalence of 42 to 73 per 100,000 adults in the United States 9 . ...
... Suggestions of treatment included alcohol and smoking cessation, pain control, replacement of pancreatic insufficiency, or mechanical drainage of obstructed pancreatic ducts for some patients 5,[9][10][11] . Some studies have suggested that patients with acute or chronic pancreatitis are more likely to have acute ASCVD, including acute myocardial infarction and stroke, compared with those without pancreatitis 7,8,10,11 . However, there is heterogeneity in these previous reports because of study limitations, such as small sample sizes 8 , inadequate control of confounding factors 7,8,10,11 , and unclear definitions of pancreatitis cases 7,9,11 . ...
... Some studies have suggested that patients with acute or chronic pancreatitis are more likely to have acute ASCVD, including acute myocardial infarction and stroke, compared with those without pancreatitis 7,8,10,11 . However, there is heterogeneity in these previous reports because of study limitations, such as small sample sizes 8 , inadequate control of confounding factors 7,8,10,11 , and unclear definitions of pancreatitis cases 7,9,11 . In addition, the influence of pancreatitis severity on the risk of acute ASCVD is unclear. ...
The association between pancreatitis and acute myocardial infarction or stroke remains incompletely understood. This study aimed to evaluate the long-term risk of acute atherosclerotic cardiovascular disease (ASCVD) in people with acute and chronic pancreatitis. Using research database of Taiwan's National Health Insurance, we identified 2678 patients aged ≥ 20 years with newly diagnosed pancreatitis in 2000–2008. A cohort of 10,825 adults without pancreatitis was selected for comparison, with matching by age and sex. Both cohorts were followed from 2000 to the end of 2013, and incident acute ASCVD was identified during the follow-up period. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of acute ASCVD associated with pancreatitis were calculated. Compared with the comparison cohort, the adjusted HR of acute ASCVD were 1.76 (95% CI 1.47–2.12) and 3.42 (95% CI 1.69–6.94) for people with acute pancreatitis and chronic pancreatitis, respectively. A history of alcohol-related illness (HR 9.49, 95% CI 3.78–23.8), liver cirrhosis (HR 7.31, 95% CI 1.81–29.5), and diabetes (HR 6.89, 95% CI 2.18–21.8) may worsen the risk of acute ASCVD in patients with chronic pancreatitis. Compared with people had no pancreatitis, patients with acute pancreatitis who had alcohol-related illness (HR 4.66, 95% CI 3.24–6.70), liver cirrhosis (HR 4.44, 95% CI 3.05–6.47), and diabetes (HR 2.61, 95% CI 2.03–3.36) were at increased risk of acute ASCVD. However, the cumulative use of metformin was associated with a reduced risk of acute ASCVD in the acute pancreatitis cohort (HR 0.30, 95% CI 0.17–0.50). Compared with the control group, patients with acute or chronic pancreatitis were more likely to have an increased risk of acute ASCVD, while the use of metformin reduced the risk of acute ASCVD. Our findings warrant a survey and education on acute ASCVD for patients with acute and chronic pancreatitis.
... 7 Other synchronized manifestations of myocardial dysfunction, such as altered cardiac input/output ratio, troponin imbalance, arrhythmia, cardiogenic shock, myocarditis and other types of MIs have also been reported in patients with SAP. [8][9][10] In addition, Saulea et al 11 observed obvious pathological ultrastructure damage such as microcirculation vessels destruction, interstitial edema, matrix collagenization, excessive contraction of myofibrils and cardiomyocytes hypoxia, edema and hypertrophy in the heart of experimental AP rats (Table 1). ...
Acute pancreatitis (AP) is one of the common acute abdominal inflammatory diseases in clinic with acute onset and rapid progress. About 20% of the patients will eventually develop into severe acute pancreatitis (SAP) characterized by a large number of inflammatory cells infiltration, gland flocculus flaky necrosis and hemorrhage, finally inducing systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS). Pancreatic enzyme activation, intestinal endotoxemia (IETM), cytokine activation, microcirculation disturbance, autonomic nerve dysfunction and autophagy dysregulation all play an essential role in the occurrence and progression of SAP. Organ dysfunction is the main cause of early death in SAP. Acute kidney injury (AKI) and acute lung injury (ALI) are common, while cardiac injury (CI) is not, but the case fatality risk is high. Many basic studies have observed obvious ultrastructure change of heart in SAP, including myocardial edema, cardiac hypertrophy, myocardial interstitial collagen deposition. Moreover, in clinical practice, patients with SAP often presented various abnormal electrocardiogram (ECG) and cardiac function. Cases complicated with acute myocardial infarction and pericardial tamponade have also been reported and even result in stress cardiomyopathy. Due to the molecular mechanisms underlying SAP-associated cardiac injury (SACI) remain poorly understood, and there is no complete, unified treatment and sovereign remedy at present, this article reviews reports referring to the pathogenesis, potential markers and treatment methods of SACI in recent years, in order to improve the understanding of cardiac injury in severe pancreatitis.
... Acute pancreatitis can be associated with electrocardiographic changes, including ST-segment deviations and T-wave changes, that can mimicking acute myocardial ischemia (22,23). However, true myocardial infarction complicating the course of acute pancreatitis has been reported in a few cases in the literatures (24,25). ...
Marijuana is a widely used illicit substance among young adults and its abuse has been reported worldwide. Marijuana is a rare trigger of acute myocardial infarction and acute pancreatitis. We present a 25-year-old man with acute pancreatitis subsequently complicated by acute ST-elevation myocardial infarction (STEMI), which was associated with marijuana abuse. This case highlights the need and importance of awareness among public about this rare but potentially lethal adverse effect. Also, it draws attention when clinicians confront patients with history of substance abuse, they should be alert to the possibility of concurrent occurrence of serious medical conditions that may be adverse effects of substance use. Acute pancreatitis with concurrent acute STEMI is a rare situation but is a challenge for many emergency physicians, and it can lead to trouble outcomes if it not be quickly diagnosed and properly managed. We demonstrate successful management in this complicated patient with primary angioplasty.
