An Uncommon Presentation of Acute MI

I wish to add ileus to the list of atypical presenting symptomsof acute myocardial infarction (MI) in an article byDrs William J. Brady, Jr, Andrew D. Perron, and Chris A.Ghaemmaghami (CONSULTANT, July 2001, page 1153).Two of my patients in whom ECG changes characteristicof acute posterior-wall MI developed initially presented withgradually progressive paralytic ileus, abdominal distension,and poor-to-absent bowel sounds. They also had a sense ofanxiety and vague distress. One patient had a temperatureof 38.3^oC (101^oF); the other was afebrile.
-Gabriel A. Covo, MD
  New York
I have also encountered patients with abdominal distention,ileus, and acute MI in my practice. They are usuallyelderly and present with altered mentation and a rangeof clinical abnormalities, including GI atony.
I have found few descriptions, however, of such apresentation for acute MI in the literature. A recent reportdescribes a 65-year-old man with chest pain, abnormalECG findings, and ileus.¹ Other papers from the 1960s reportan association between ileus and acute MI-either asa presenting sign² or as a noncardiovascular complicationthat developed after admission for acute MI.³
It would be rare for an ileus to be the sole presentingsymptom of acute MI. An elderly patient who presentswith a change in mental status may be experiencing acuteMI as either the cause of the presenting symptoms or acomplication of the responsible illness. An ileus certainlywould be a feature of such a presentation-but not thesole clinical issue.
-William J. Brady, Jr, MD
  Associate Professor of Emergency Medicine and
  Internal Medicine
  Director, Emergency Medicine Residency Program
  Vice-Chairman of Emergency Medicine
  University of Virginia School of Medicine
  Charlottesville

References:

REFERENCE:

1.

Reymond JM, Sztajzel J. Severe chest pain, diagnostic electrocardiogram, andileus. Lancet. 1996;348:1560.

2.

Lotto A, Gallioli G, Capelli F, Bevilacqua G. Atypical myocardial infarct withabdominal symptoms: etiopathogenetic and clinical considerations on 20 cases.Mal Cardiovasc. 1966;7:595-642.

3.

Heltzman EJ, Fulmer CM, Sanborn JC. Paralytic ileus following myocardialinfarction. Am J Cardiol. 1965;16:887-893.