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Coronary thrombosis in acute pancreatitis

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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.

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References

  1. Khairy P, Marsolais P (2001) Pancreatitis with electrocardiographic changes mimicking acute myocardial infarction. Can J Gastroenterol 15(8):522–526

    CAS  PubMed  Google Scholar 

  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.e4

    Google Scholar 

  3. Wu CH, Wang KL, Lu TM (2010) Perplexing epigastric pain-coincident myocardial infarction and acute pancreatitis. Intern Med 49(2):149–153

    PubMed  Google Scholar 

  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):932–935

    PubMed  Google Scholar 

  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 51:899–905

    PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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 107:1579–1585

    CAS  PubMed  Google Scholar 

  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):1269–1275

    CAS  PubMed  Google Scholar 

  9. de Stoppelaar SF, van ‘t Veer C, van der Poll T (2014) The role of platelets in sepsis. Thromb Haemost 112(4):666–677

    PubMed  Google Scholar 

  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: 111–116

    CAS  PubMed  Google Scholar 

  11. Esmon CT (2005) The interactions between inflammation and coagulation. Br J Haematol 131(4):417–430

    CAS  PubMed  Google Scholar 

  12. Schuliga M (2015) The inflammatory actions of coagulant and fibrinolytic proteases in disease. Mediat Inflamm. https://doi.org/10.1155/2015/437695

    Article  Google Scholar 

  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):353–362

    PubMed  PubMed Central  Google Scholar 

  14. Jurk K (2015) Analysis of platelet function and dysfunction. Hamostaseologie 35(1):60–72

    CAS  PubMed  Google Scholar 

  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):1399–1403

    PubMed  Google Scholar 

  16. Levi M, Keller TT, van Gorp E, ten Cate H (2003) Infection and inflammation and the coagulation system. Cardiovasc Res 60(1):26–39

    CAS  PubMed  Google Scholar 

  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–G153

    CAS  PubMed  Google Scholar 

  18. Esmon CT (2005) Coagulation inhibitors in inflammation. Biochem Soc Trans 33(Pt 2):401–405

    CAS  PubMed  Google Scholar 

  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):87–92

    PubMed  Google Scholar 

  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):2023

    PubMed  Google Scholar 

  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 50:933–939

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Saagar Sanghvi

  2. Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Fahad Waqar & Mohamed Effat

Authors
  1. Saagar Sanghvi
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  2. Fahad Waqar
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  3. Mohamed Effat
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Correspondence to Fahad Waqar.

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All authors declare that they have no conflict of interest.

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Sanghvi, S., Waqar, F. & Effat, M. Coronary thrombosis in acute pancreatitis. J Thromb Thrombolysis 47, 157–161 (2019). https://doi.org/10.1007/s11239-018-1741-z

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  • DOI: https://doi.org/10.1007/s11239-018-1741-z

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