Dilema v léčbě pacienta s akutním infarktem myokardu a vysokým rizikem recidivy masivního krvácení do gastrointestinálního traktu
| Title in English | Dilemma in the treatment of patients with acute myocardial infarction and a high risk of recurrence of massive gastrointestinal bleeding |
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| Authors | |
| Year of publication | 2020 |
| Type | Article in Periodical |
| Magazine / Source | Cor et Vasa Case Reports |
| MU Faculty or unit | |
| Citation | |
| Web | https://www.cksonline.cz/coretvasa-case-reports/clanky.php?p=detail&id=138&pid=1409 |
| Keywords | Acute myocardial infarction; Cardiac magnetic resonance; Gastrointestinal bleeding; Percutaneus coronary intervention |
| Description | Percutaneous coronary intervention (PCI) is a routine therapy in the setting of acute myocardial infarction. We report a case of a younger man without any common risk factors of coronary artery disease who was admitted to the cardiology department with non-ST-segment elevation myocardial infarction and history of gastrointestinal bleeding and anaemia. Acute coronarography revealed 80% stenosis of the left anterior descending artery as a single-vessel disease. Taking into account the ongoing ischemia we proceeded to acute coronary intervention with stent implantation despite a very high risk of massive gastrointestinal rebleeding that had not been objectified at the moment of PCI. Subsequent endoscopic examinations excluded peptic ulcers and confirmed the diagnosis of haemorrhoids and signs of subacute colitis. Dual antiplatelet therapy was well tolerated by the patient without any adverse events. From the gastroenterological point of view, this approach was quite risky considering the unresolved gastrointestinal bleeding and the expected need of dual antiplatelet therapy for at least 1 month. Finally, we discuss the difficulties to decide between the risk of bleeding and thrombosis in the field of both gastroenterology and cardiology. Last but not least, we were surprised by the location of the myocardial scar identified by cardiac magnetic resonance, which showed tremendous variability in the coronary artery blood supply to myocardial segments. |