title: A study of the syndrome of simultaneous acute upper gastrointestinal bleeding and myocardial infarction in 36 patients.
abstract: OBJECTIVE
  To analyze how acute upper gastrointestinal bleeding (GIB) with simultaneous myocardial infarction (MI) presents differently than either disease alone.
  
  
  METHODS
  A multicenter, case-controlled study of 36 study patients with simultaneous upper GIB and MI was conducted. GIB-post-MI controls were 28 patients developing upper GIB more than 24 h after MI. MI controls were 36 patients with MI without GIB. GIB controls were 36 patients with upper GIB without MI.
  
  
  RESULTS
  Study patients had more severe bleeding than GIB controls as indicated by significantly more units transfused and lower mean arterial pressure (74.8 +/- 17.3 mm Hg vs 88.7 +/- 14.9 mm Hg, p < 0.001, Student's t test). Massive bleeding may contribute to myocardial hypoperfusion and infarction. Study patients were significantly more likely than patients in any control group to present with syncope, dizziness, or confusion (e.g., study group, 56%, GIB-post-MI controls, 21%, odds ratio = 4.58, p < 0.01, chi 2). Neurological symptoms in study patients were usually attributable to hypovolemia, but in GIB-post-MI controls, all cases were attributable to arrhythmia or hypoxia and not hypovolemia (13 vs 0, p < 0.0002, Fisher's exact test). Syncope rarely led to neurological sequelae. Study patients tended to experience chest pain less frequently than GIB-post-MI or MI controls. Study patients had significantly greater mortality than either GIB controls (33 vs 8%, odds ratio = 5.5, p < 0.01, Fisher's exact test) or MI controls.
  
  
  CONCLUSIONS
  Gastrointestinal findings generally predominate in patients with simultaneous upper GIB and MI. This syndrome is typically characterized by: massive bleeding; frequent syncope, dizziness, or confusion; rare neurological sequelae; moderately frequent absence of chest pain; and high mortality. MI may not be clinically suspected. Patients with upper GIB who deny chest pain but have warning signs of hypoperfusion such as syncope, confusion, dizziness, or hypotension should have MI excluded in an intensive care unit.
authors.affiliation: Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Cappell
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D016017:Odds Ratio; D013577:Syndrome; D016896:Treatment Outcome