Simultaneous Myocardial and Mesenteric Ischemia Mimicking Each Other in an Older Patient.

BACKGROUND

The rare co-occurrence of acute mesenteric ischemia (AMI) and myocardial infarction (MI) poses significant diagnostic and therapeutic challenges.

CASE SUMMARY: An 87-year-old woman with epigastric pain was initially diagnosed with an acute inferior ST-segment elevation MI and successfully treated with percutaneous coronary intervention. Persistent symptoms led to further investigation, revealing concurrent AMI. Her condition worsened with superior mesenteric artery occlusion and gastrointestinal bleeding due to excessive anticoagulation. A multidisciplinary conservative approach using heparin and proton pump inhibitors managed the dual risks of thrombosis and hemorrhage, resulting in rapid improvement and discharge.

DISCUSSION: Differentiating acute inferior MI from AMI is challenging due to overlapping symptoms in older patients. Multidisciplinary collaboration is key to managing these complex cases effectively.

TAKE-HOME MESSAGES: Shared risk factors and overlapping symptoms make distinguishing AMI from MI difficult in older patients. Effective management requires a broad differential diagnosis during clinical changes and strong multidisciplinary cooperation.