Management of Patient with Simultaneous Overt Gastrointestinal Bleeding and Myocardial Infarction with ST Segment Elevation: A Case Report

Authors

  • Jakub Nozewski Faculty of Health Sciences, Emergency Department, Nicolaus Copernicus University, Bydgoszcz, Poland.
  • Grzegorz Grzesk Faculty of Health Sciences, Department of Cardiology and Clinical Pharmacology, Nicolaus Copernicus University, Bydgoszcz, Poland.
  • Maria Klopocka Faculty of Health Science, Vice-dean for education and development, Department of Gastroenterology, Nicolaus Copernicus University, Bydgoszcz, Poland.
  • Michal Wicinski Faculty of Medicine, Vice-dean for students affairs, Department of Pharmacology and Therapy, Nicolaus Copernicus University, Bydgoszcz, Poland.
  • Klara Nicpon-Nozewska Faculty of Health Sciences, Department and Clinic of Geriatrics, Nicolaus Copernicus University, Bydgoszcz, Poland.
  • Jakub Konieczny Clinic of Emergency, Biziel’s Hospital, Bydgoszcz, Poland.
  • Adam Wlodarczyk Faculty of Medicine, Department of Psychiatry, Medical University of Gdansk, Poland.

DOI:

https://doi.org/10.9734/bpi/etdhr/v3/15323D

Keywords:

Upper gastrointestinal bleeding, acute coronary syndrome, antiplatelet and anticoagulant therapy, hemorrhage shock, proton pomp inhibitors, endoscopy

Abstract

Background: The current ERC guidelines have resulted in numerous positive changes, including a reduction in mortality, length of hospitalization, and an improvement in the prognosis of STEMI patients. However, there is a small group of patients for whom a minor change in guidelines would reduce in-hospital mortality and hospitalization costs even further. These are patients who have a STEMI infarction as well as gastrointestinal bleeding.

Methods: In patients with concomitant gastrointestinal bleeding and ST segment elevation myocardial infarction, two treatment methods were compared. The first is a traditional approach that adheres to ESC guidelines, while the second is innovative and priorities endoscopy.

Results: Despite the novel approach, the patient who underwent endoscopy prior to PCI was discharged without complications. A patient who underwent coronary intervention and was started on standard antiplatelet therapy prior to a gastroenterological diagnosis died as a result of massive bleeding.

Conclusion: For ethical reasons and in accordance with the cardiological guidelines of the management of ACS, a study of patients with ASC a high risk of intestinal bleeding , in which endoscopy will have priority, and only later PCI, will probably never be performed. However, as demonstrated by the described case, despite exceeding the 90-minute time limit for implementing PCI (120-minutes), such behavior is entirely feasible.

Published

2022-02-14

How to Cite

Jakub Nozewski, Grzegorz Grzesk, Maria Klopocka, Michal Wicinski, Klara Nicpon-Nozewska, Jakub Konieczny, & Adam Wlodarczyk. (2022). Management of Patient with Simultaneous Overt Gastrointestinal Bleeding and Myocardial Infarction with ST Segment Elevation: A Case Report. Emerging Trends in Disease and Health Research Vol. 3, 21–34. https://doi.org/10.9734/bpi/etdhr/v3/15323D

Issue

Emerging Trends in Disease and Health Research Vol. 3

Section

Chapters