title: Acute pancreatitis complicated by ST-elevation myocardial infarction.
abstract: BACKGROUND
  Electrocardiographic abnormalities mimicking myocardial ischemia have been reported in intra-abdominal conditions, including acute pancreatitis. However, the occurrence of ST-elevation myocardial infarction (STEMI) is rare.
  
  
  OBJECTIVE
  To present a case report of a young man with acute pancreatitis subsequently complicated by acute STEMI. The diagnosis and management of STEMI in acute pancreatitis can present unique diagnostic and therapeutic challenges, which are reviewed.
  
  
  METHODS
  A 31-year-old man with no conventional coronary risk factors presented with acute abdominal pain, elevated pancreatic enzymes, and computed tomography scan findings of acute pancreatitis. The patient developed chest discomfort and presented to us on Day 2 with electrocardiographic evidence of an evolved extensive anterior wall myocardial infarction. Cardiac troponin I levels were elevated, and the electrocardiogram showed regional wall motion abnormalities in the left anterior descending territory (LAD). Coronary angiography done after stabilization showed a thrombus in the LAD, with no atherosclerotic lesions whatsoever. Hemostatic abnormalities are known in acute pancreatitis, and the development of a transient hypercoagulable state may be responsible for thrombotic complications. The overlap of some of the symptoms of the two conditions may cause diagnostic difficulty. Management issues include the choice of revascularization therapy, the safety of antiplatelet and anticoagulant therapy, intravenous fluid administration, and the use of cardiac medications that potentially can cause hypotension.
  
  
  CONCLUSIONS
  The diagnosis and management of STEMI in the setting of acute pancreatitis can be challenging. In the absence of guidelines, a multidisciplinary approach individualized to the patient's clinical situation may be most appropriate.
authors.affiliation: Department of Cardiology, TN Medical College and BYL Nair Charitable Hospital, Mumbai, India.
authors.forename: Milind S
authors.initials: MS
authors.lastname: Phadke
authors.forename: Pritesh
authors.initials: P
authors.lastname: Punjabi
authors.forename: Sohan
authors.initials: S
authors.lastname: Sharma
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kide
authors.forename: Jaywant
authors.initials: J
authors.lastname: Nawale
authors.forename: Ajay
authors.initials: A
authors.lastname: Chaurasia
mesh_terms: D000328:Adult; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis*; D010195:Pancreatitis / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D019210:Troponin I / Q000097:blood
chemical_list: D019210:Troponin I