Management of patient with concomitant upper gastrointestinal bleeding and myocardial infarction: two cases report and literature review

Document Type : Case Series

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Gastroenterology Department, Da Nang general Hospital, Viet Nam

Abstract

Background: Patients with simultaneous upper gastrointestinal bleeding (UGIB) and acute myocardial infarction (AMI) have higher mortality than whom with either GIB or AMI. No offical guideline about this challenging situation has been published. The prior choice either gastrointestinal endoscopy (GIE) or coronary artery revascularization (CAR) remains controversial.
Case presentation: First case, a 55-years-old female patient with concomitant severe upper gastrointestinal bleeding and non ST elevation myocardial infarction. The priority endoscopy strategy was done and patient was successfully treated with 18 months follow-up. Second case, 45-years-old male patient with ST elevation myocardial infarction and concomitant upper gastrointestinal bleeding. The priority coronary artery revascularization strategy was done and patient was successfully treated with 32 months follow-up.
Conclusion: Working in team of cardiologists, gastroenterologists, anesthesiologists and individualized treatment are optimal. Risks and benefits must be carefully considered base on the optimal time for each strategy and type of acute myocardial infarction. The priority gastrointestinal endoscopy is safe and prefer in case of immediate coronary revascularization is not mandatory. Nevertheless, this approach needs further studies to obtain optimal strategy for management of this instance.

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