Acute Necrotizing Pancreatitis Complicated with St Elevation Acute Myocardial Infarction: A Case Report and Literature Review

急性壞死性胰臟炎併發ST段上升之急性心肌梗塞：個案報告及文獻回顧

許栢超(Po-Chao Hsu) ； 林宗憲(Tsung-Hsien Lin) ； 蘇河名(Ho-Ming Su) ； 林子堯(Zu-Yau Lin) ； 賴文德(Wen-Ter Lai) ； 許勝雄(Sheng-Hsiung Sheu)

《The Kaohsiung Journal of Medical Sciences》 26卷4期 (2010/04) Pp. 200-205

摘要

急性胰臟炎併發急性心肌梗塞在過去的文獻中是相當罕見的，而且造成此心肌受損的詳細機轉目前仍然不明確。我們報告一位以上腹痛為表現之49歲男性，他因為急性壞死性胰臟炎而住院，接著發生了ST段上升之急性心肌梗塞。病人最後因為嚴重之心衰竭以及逐漸惡化之壞死性胰臟炎而死亡。雖然針對此類病患之標準治療方法尚未被確立，根據過去有限的病例，使用血栓溶解劑治療可能會導致嚴重之合併症。因此我們建議冠狀動脈攝影術應該是較佳的選擇。在這一類的患者，若有需要，進一步的介入性治療，如氣球擴張術以及支架置放術也應該被施行。

關鍵字

急性冠心症 ； 急性心肌梗塞 ； 急性胰臟炎 ； 胰臟

並列摘要

Acute pancreatitis complicated with acute myocardial infarction has rarely been reported and the precise mechanisms of myocardial injury remain unclear. We report a 49-year-old man presenting with epigastralgia who had been hospitalized for acute necrotizing pancreatitis, and who subsequently developed ST elevation myocardial infarction. The patient eventually died because of severe heart failure and complications of progressive necrotizing pancreatitis. Although a standard management protocol for these patients has not yet been developed, administration of thrombolytic agents may cause severe complications based on the limited case reports already published. We suggest that coronary angiography and further interventions such as angioplasty and possibly stenting should be performed in these cases.

並列關鍵字

acute coronary syndrome ； acute myocardial infarction ； acute pancreatitis ； pancreas