Management of Patient with Simultaneous Overt Gastrointestinal Bleeding and Myocardial Infarction with ST Segment Elevation: A Case Report

Background: The current ERC recommendations have resulted in a number of favourable outcomes, including a decrease in mortality, a shorter stay in the hospital, and a better prognosis for STEMI patients. A little modification in guidelines, on the other hand, would lower in-hospital mortality and hospitalisation expenses even more for a small group of patients. Patients with a STEMI infarction and gastrointestinal bleeding fall into this category.

Two treatment approaches were examined in patients with concurrent gastrointestinal bleeding and ST segment elevation myocardial infarction. The first is a standard method that follows ESC rules, whereas the second is more innovative and places a higher priority on endoscopy.

The patient who received endoscopy prior to PCI was released without difficulties, despite the new method. Prior to a gastroenterological diagnosis, a patient who underwent coronary intervention and was started on normal antiplatelet medication died as a result of significant bleeding.

Conclusion: For ethical considerations and in accordance with cardiological recommendations for the therapy of ACS, a study of patients with ASC who have a high risk of intestinal bleeding, in which endoscopy is prioritised and PCI is performed only later, will almost certainly never be conducted. However, as illustrated by the stated scenario, such behaviour is fully possible despite surpassing the 90-minute time limit for implementing PCI (120-minutes).

Author(S) Details

Jakub Nozewski
Faculty of Health Sciences, Emergency Department, Nicolaus Copernicus University, Bydgoszcz, Poland.

Grzegorz Grzesk
Faculty of Health Sciences, Department of Cardiology and Clinical Pharmacology, Nicolaus Copernicus University, Bydgoszcz, Poland.

Maria Klopocka
Faculty of Health Science, Vice-dean for education and development, Department of Gastroenterology, Nicolaus Copernicus University, Bydgoszcz, Poland.

Michal Wicinski
Faculty of Medicine, Vice-dean for students affairs, Department of Pharmacology and Therapy, Nicolaus Copernicus University, Bydgoszcz, Poland.

Klara Nicpon-Nozewska
Faculty of Health Sciences, Department and Clinic of Geriatrics, Nicolaus Copernicus University, Bydgoszcz, Poland.

Jakub Konieczny
Clinic of Emergency, Biziel’s Hospital, Bydgoszcz, Poland.

Adam Wlodarczyk
Faculty of Medicine, Department of Psychiatry, Medical University of Gdansk, Poland.

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