Coexisting upper gastrointestinal bleeding and myocardial infarction: Two Case Reports

Tóm tắt

Background

Patients presenting with both upper gastrointestinal bleeding (UGIB) and acute myocardial infarction (AMI) have a higher mortality rate compared to those with either condition alone. Currently, there is no official guideline addressing the management of this challenging situation. The optimal approach, whether it should be gastrointestinal endoscopy (GIE) or coronary artery revascularization (CAR) is controversial.

Results

In the first case, a 55-year-old female patient experienced severe upper gastrointestinal bleeding along with non-ST elevation myocardial infarction. The priority strategy involved performing endoscopy, which led to successful treatment, with the patient remaining stable during the 18-month follow-up period. In the second case, a 45-year-old male patient presented with ST elevation myocardial infarction and concurrent upper gastrointestinal bleeding. The priority strategy in this case was coronary artery revascularization, which resulted in successful treatment, with the patient remaining stable during the 32-month follow-up period

Conclusion

Optimal management of patients with simultaneous UGIB and AMI requires a multidisciplinary team approach involving cardiologists, gastroenterologists, and anesthesiologists. Individualized treatment plans should be developed, carefully weighing the risks and benefits based on the specific timing and type of acute myocardial infarction. Gastrointestinal endoscopy can be safely prioritized in cases where immediate coronary revascularization is not mandatory. However, further research is needed to establish an optimal management strategy for this complex scenario.