Acute pancreatitis is an inflammatory condition with different spectrum of local and systemic complications. Acute myocardial infarction is rarely reported complication of acute pancreatitis. We report a case of 56 year old female presenting with acute pancreatitis complicated by true non ST elevation acute myocardial infarction (AMI). On investigation there was raised serum amylase, lipase and cardiac troponin. Electrocardiogram (ECG) was suggestive anterolateral wall ischemia. Contrast computerized tomography abdomen revealed acute severe pancreatitis. In acute pancreatitis, Nonspecific ECG changes can occur. The diagnosis of true myocardial infarction in setting of acute pancreatitis can be challenging even using ECGs, 2D echocardiography, cardiac biomarkers and coronary angiography. Choice of revascularization therapy and use of antiplatelet agents and anticoagulant therapy is also challenging. Decision making regarding the management of such a patient is also critical.

Keywords: Acute pancreatitis, Acute coronary syndrome, Acute myocardial infarction, Non STEMI and ECG abnormalities.

1. Faintuch JJ, Abrahao MM, Giacaglia LR,et al. Electrocardiographic changes in pancreatitis. Arq Bras Cardiol.1989; 52:259-60.
2. Pezzilli, R, Barakat B, Billi P,etal. Electrocardiographic abnormalities in acute pancreatitis. Eur J Emerg Med. 1999;6:27-9.
3. Morrison M.L, Swulim W.A Role of the gastrointestinal treat in production of cardiac symptoms. Experimental and clinical observation. J Am Med Assoc.1940; 114:217.
4. Lieberman JS, Taylor A, Wright IS. The effect of intravenous trypsin administration on the electrocardiogram of the rabbit. Circulation. 1954;10:338-342.(PubMed).
5. Kellner A, Robertston. T. Selective necrosis of cardiac and skeletal muscle induced experimentally by means of proteolytic enzymes solution given intravenously. J Exp Med. 1954;99:387-404 (PubMed).
6. Gulio L, Stella A, Labo G. Cardiovascular lesions in chronic pancreatitis. Dig Dis Sci.1982;27:716-722.(PubMed).
7. Spritzer HW, Peterson CR, Jones CR,etal. Electrocardiographic abnormalities in acute pancreatitis: two patients studies by selective coronary arteriography. Milit Med. 1969;134:687-693. (Pub.Med).
8. Korantzo Poulos P, Pappa E,Dimitrolua V,etal.ST segment elevation pattern and myocardial injury induced by acute pancreatitis. Cardiology. 2005;103:128-130. (PubMed).
9. Hsu Po Chao, Liw Tsung Hsien, Su Ho Ming, Liw ZU Yau, Lai Wew Ter, Sheu Sheng-Hsiung. Acute necrotizing pancreatitis complicated with ST elevation acute myocardial infarction; a case report and literature review. Kaohsiung J Med Sci.2010;26:200-205(PubMed).
10. Mann G, Heeth D, Candilsh W,etal. Dangers of thrombolysis, BMJ. 1990;300:811. (PubMed).
11. Cafri C., Basok A., Katz A. Thromgolytic therapy in acute pancreatitis presenting as acute myocardial infarction. Int J Cardiol. 1995;49:279-281. (PubMed).
12. Qazi YA, Sekovski B,Qazi KJ. Is thromgolysic therapy an option in myocardial infarction with acute pancreatitis? AM J Med. 2000;108:178 (PubMed).

Dr Gopal Singh, MD Anesthesia

Department of Anaesthesia Zonal Hospital, Dharamshala H.P., India