Myocardial damage may be linked to upper GI bleeds.
"An upper GI bleed is like giving a person a stress test. Patients can become hypotensive and have tachycardia," Dr. Alexander J.V. Thompson said in a poster presentation at the annual Digestive Disease Week.
The best way to identify these patients is with an assay for cardiac troponin I (cTnI), said Dr. Thompson, a gastroenterologist at St. Vincent's Hospital Melbourne (Australia). Patients with serum cTnI greater than 2.0 [micro]g/L have had myocardial damage. A cTnI assay should be done on all patients with an upper gastrointestinal bleed who have other risk factors for coronary disease: age older than 65 years, presentation with hypotension (systolic pressure of less than 100 mm Hg) and significant anemia, and a history of ischemic heart disease.
These patients can still undergo endoscopy to diagnose and treat their gastrointestinal bleeding, Dr. Thompson said. But if there is coexisting myocardial damage, the physician should be prepared for complications. In the series reviewed by Dr. Thompson and his associates, patients with elevated troponin levels had an increased risk for endoscopic complications and rebleeding after the procedure. In addition, following their endoscopic work-up, these patients should be referred to a cardiologist for further assessment and risk-factor modification, he said.
Dr. Thompson reviewed a series of 156 patients with hematemesis and melena seen at the St. Vincent's gastroenterology unit during January-September 2003. Their average age was 67 years, and 67% were men. Serial assays for cTnI were done at baseline and after 12 and 24 hours.
At least one measure of cTnI above 2.0 [micro]g/L was found in 15 patients (9.6%). An additional 15 patients had indeterminate levels of cTnI, from 0.5-2.0 [micro]g/L.
BY MITCHEL L. ZOLER
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|Author:||Zoler, Mitchel L.|
|Publication:||Internal Medicine News|
|Article Type:||Brief Article|
|Date:||Sep 15, 2004|
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