| Abstract: |
Upper gastrointestinal bleeding (UGIB) and myocardial ischemia/infarction may occur simultaneously because massive UGIB compromises myocardial perfusionand reflex tachycardia increases myocardial oxygen consumption. Myocardial injury after UGIB is frequently ignored because the signs and symptoms may be overshadowed by severe UGIB. The aims of this study were to investigate the predictive risk factors of simultaneous upper gastrointestinal bleeding (UGIB) and myocardial injury using parameters including troponin I (TnI); and evaluate the epidemiologyof this syndrome.Subject and methods: : This study was a case-control study carried out at the gastrointestinal subunit of medical intensive care unit of Internal Medicine department, Faculty of Medicine, Zagazig University. One hundred and five patients were included in this work presenting with UGIB. All participants were subjected to thorough history taking, clinical examination. Routine investigations including complete blood picture, renal function tests, bleeding profile, serum NA+ and K+ , arterial blood gases, lipid profile, fasting and post prandial blood glucose level and C-reactive protein. Also abdominal ultrasonography ,upper GIT endoscopy and studies of myocardial injury including ECG, echocardiography and cadiac enzymes including CK, CK-MB and TnI.Results: Myocardial injury show no significant difference among patients with variceal bleeding and those with non variceal bleeding .After adjusting for significant risk factors revealed by the univariate analysis, UGIB patients with a history of liver cirrhosis and more than three cardiac risk factors including systemic hypertension, smoking , BMI and hypertriglyceridaemia had a high risk of simultaneously developing myocardial injury. Longer hospital stay was found in those patients.. Other factors including age, gender, the color of nasogastric tube irrigation fluid, history of nonsteroidal anti-inflammatory drug use, octeriotide or terlipressin administration, vital signs, and creatinine recorded at the ED were not significant predictors. Those who developed myocardial injury had a longer hospital stay (mean duration, 4.3±1.5 vs. 11.5±3.5 days; p<0.001) and not required transfusion of more units of packed erythrocytes.Conclusions: UGIB patients with a history of liver cirrhosis and more than three cardiac risk factors had a high risk of simultaneously developing myocardial injury. Monitoring ECG and cardiac enzymes, including TnI, are recommended in highrisk patients, even if no chest complaints are present. Further studies are necessary to investigate the exact mechanisms by which liver cirrhosis precipitates myocardial injury during UGIB.Key Words: myocardial injury, troponin I, upper gastrointestinal bleeding.
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