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Journal of Thrombosis and Thrombolysis

, Volume 47, Issue 1, pp 157–161 | Cite as

Coronary thrombosis in acute pancreatitis

  • Saagar Sanghvi
  • Fahad WaqarEmail author
  • Mohamed Effat
Article

Abstract

The incidence of acute myocardial infarction in the setting of acute pancreatitis is very rare. The recognition of such complex diagnosis may be clinically challenging, as the symptoms of both conditions are often indistinguishable. We report a case in which we encountered both conditions concurrently, and hypothesize that the ambient inflammatory and pro-thrombotic milieu of acute pancreatitis resulted in acute coronary thrombosis despite the absence of significant coronary atherosclerosis. Among multiple coronary imaging modalities currently in use, optimal cohesion tomography provided a unique capability for direct visualization of the coronary thrombus. (1) Inflammatory processes such as acute pancreatitis promote a thrombogenic state. (2) Presentation of acute myocardial infarction is variable and can mimic a variety of medical conditions. (3) Intravascular imaging is emerging as a useful tool in delineating details of intra-coronary pathology not clear on standard fluoroscopy. (4) The above case highlights the likely concurrence of pathologies that follow common pathways such as system-wide inflammation and coagulation. Clinicians must be aware of this uncommon yet very likely possibility and keep a low threshold to perform ECG and cardiac biomarker testing if symptoms are suggestive of a myocardial infarction, even in the presence of a clear alternative diagnosis.

Keywords

Coronary thrombosis Acute pancreatitis Acute myocardial infarction 

Notes

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

References

  1. 1.
    Khairy P, Marsolais P (2001) Pancreatitis with electrocardiographic changes mimicking acute myocardial infarction. Can J Gastroenterol 15(8):522–526CrossRefGoogle Scholar
  2. 2.
    Makaryus AN, Adedeji O, Ali SK (2008) Acute pancreatitis presenting as acute inferior wall ST-segment elevations on electrocardiography. Am J Emerg Med 26(6):734.e1–734.e4Google Scholar
  3. 3.
    Wu CH, Wang KL, Lu TM (2010) Perplexing epigastric pain-coincident myocardial infarction and acute pancreatitis. Intern Med 49(2):149–153CrossRefGoogle Scholar
  4. 4.
    Phadke MS, Punjabi P, Sharma S, Kide S, Nawale J, Chaurasia A (2013) Acute pancreatitis complicated by ST-elevation myocardial infarction. J Emerg Med 44(5):932–935CrossRefGoogle Scholar
  5. 5.
    Kelbaek H, Terkelsen CJ, Helqvist S et al (2008) Randomized comparison of distal protection versus conventional treatment in primary percutaneous coronary intervention: the drug elution and distal protection in ST elevation myocardial infarction (DEDICATION) trial. J Am Coll Cardiol 51:899–905CrossRefGoogle Scholar
  6. 6.
    Xu W, Qi X, Chen J, Su C, Guo X (2015) Prevalence of splanchnic vein thrombosis in pancreatitis: a systematic review and meta-analysis of observational studies. Gastroenterol Res Pract.  https://doi.org/10.1155/2015/245460 Google Scholar
  7. 7.
    Rebours V, Boudaoud L, Vullierme MP, Vidaud D, Condat B et al (2012) Extrahepatic portal venous system thrombosis in recurrent acute and chronic alcoholic pancreatitis is caused by local inflammation and not thrombophilia. Am J Gastroenterol 107:1579–1585CrossRefGoogle Scholar
  8. 8.
    Laufer EM, Mingels AM, Winkens MH et al (2010) The extent of coronary atherosclerosis is associated with increasing circulating levels of high sensitive cardiac troponin T. Arterioscler Thromb Vasc Biol 30(6):1269–1275CrossRefGoogle Scholar
  9. 9.
    de Stoppelaar SF, van ‘t Veer C, van der Poll T (2014) The role of platelets in sepsis. Thromb Haemost 112(4):666–677Google Scholar
  10. 10.
    Salomone T, Tosi P, Palareti G, Tomassetti P, Migliori M et al (2003) Coagulative disorders in human acute pancreatitis: role for the D-dimer. Pancreas 26: 111–116CrossRefGoogle Scholar
  11. 11.
    Esmon CT (2005) The interactions between inflammation and coagulation. Br J Haematol 131(4):417–430CrossRefGoogle Scholar
  12. 12.
    Schuliga M (2015) The inflammatory actions of coagulant and fibrinolytic proteases in disease. Mediat Inflamm.  https://doi.org/10.1155/2015/437695 Google Scholar
  13. 13.
    Yan SL, Russell J, Granger DN (2014) Platelet activation and platelet-leukocyte aggregation elicited in experimental colitis are mediatedby interleukin-6. Inflamm Bowel Dis 20(2):353–362CrossRefGoogle Scholar
  14. 14.
    Jurk K (2015) Analysis of platelet function and dysfunction. Hamostaseologie 35(1):60–72CrossRefGoogle Scholar
  15. 15.
    Zhu R, Wei S, Wu C, Li S, Gong J (2012) Utility of clot formation and lysis assay to monitor global coagulation state of patients with severe acute pancreatitis. Dig Dis Sci 57(5):1399–1403CrossRefGoogle Scholar
  16. 16.
    Levi M, Keller TT, van Gorp E, ten Cate H (2003) Infection and inflammation and the coagulation system. Cardiovasc Res 60(1):26–39CrossRefGoogle Scholar
  17. 17.
    Sun J, Bhatia M (2007) Blockade of neurokinin-1 receptor attenuates CC and CXC chemokine production in experimentalacute pancreatitis and associated lung injury. Am J Physiol Gastrointest Liver Physiol 292(1):G143–G153CrossRefGoogle Scholar
  18. 18.
    Esmon CT (2005) Coagulation inhibitors in inflammation. Biochem Soc Trans 33(Pt 2):401–405CrossRefGoogle Scholar
  19. 19.
    Maeda K, Hirota M, Ichihara A, Ohmuraya M, Hashimoto D, Sugita H et al (2006) Applicability of disseminated intravascular coagulation parameters in the assessment of the severity of acute pancreatitis. Pancreas 32(1):87–92CrossRefGoogle Scholar
  20. 20.
    Barlis P, Serruys PW, Devries A, Regar E (2008) Optical coherence tomography assessment of vulnerable plaque rupture: predilection for the plaque ‘shoulder’. Eur Heart J 29(16):2023CrossRefGoogle Scholar
  21. 21.
    Kubo T, Imanishi T, Takarada S et al (2007) Assessment of culprit lesion morphology in acute myocardial infarction: ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy. J Am Coll Cardiol 50:933–939CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Internal MedicineUniversity of Cincinnati College of MedicineCincinnatiUSA
  2. 2.Division of Cardiovascular Health and Disease, Department of Internal MedicineUniversity of Cincinnati College of MedicineCincinnatiUSA

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