RESUMEN
(1) Background: Recent studies suggest an association between pancreatitis and cardiovascular disease. This article aims to review the available evidence linking cardiovascular disease with acute and chronic pancreatitis. (2) Methods: A comprehensive search was conducted on the PubMed/MEDLINE database from inception to April 2022 using Medical Subject Heading and keywords related to pancreatitis and cardiovascular disease. The search was limited to English-language literature involving human subjects, and various study types, including observational studies, case-control studies, cohort studies, and clinical trials, were screened for eligibility. Following data extraction, the authors conducted a narrative synthesis of the studies. (3) Results: Longitudinal studies indicate that a history of acute pancreatitis is associated with an increased risk of acute atherosclerotic cardiovascular disease and acute coronary syndrome. Elevated triglyceride levels (>2000 mg/dL) have a temporal relationship with acute pancreatitis. Cross-sectional studies have shown that acute pancreatitis is associated with cardiac injury during the acute phase. Based on longitudinal studies, chronic pancreatitis is associated with an increased risk of cerebrovascular diseases. However, data regarding the relationship between chronic pancreatitis and myocardial infarction are conflicting. (4) Conclusions: Based on the available evidence, having a history of acute pancreatitis appears to increase the risk of acute atherosclerotic cardiovascular disease. However, there is insufficient evidence to conclude whether chronic pancreatitis is associated with cardiovascular disease, and no definitive studies have yielded conflicting results.
RESUMEN
The reported annual incidence of acute ischemic stroke (AIS) among pediatric and young adults is 1-13/100,000. In adults, ischemic stroke is attributed to several risk factors such as smoking, hypertension, atherosclerosis, and diabetes. Alternatively, pediatric ischemic stroke is associated with a broad spectrum of etiologies including prematurity, congenital heart disease, arteriopathies like moyamoya, chronic inflammatory disease, sickle cell, hypercoagulability, and malignancy. In rare cases, AIS has been associated with multisystem inflammatory syndrome in children (MIS-C), a Kawasaki-like inflammatory disease affecting patients younger than 21 years of age. This recently recognized and rare condition has been linked to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and presentations can vary widely in terms of severity and systemic involvement. While the exact reason behind this association is unknown, there is a growing body of evidence in adult literature that links SARS-CoV-2 infection to hypercoagulability and immune-mediated thrombosis. In pediatric patients, this association is not very clear. We report a case of a 17-year-old, previously healthy male who presented with acute-onset expressive aphasia, right-sided hemiparesis, and facial droop after two weeks from experiencing coronavirus disease 2019 (COVID-19)-like symptoms. A non-contrast head CT revealed an acute left M2 territory infarct while serum workup was consistent with MIS-C. Providers must maintain a high degree of suspicion and consider AIS in pediatric patients presenting with even mild neurological changes and a recent history of SARS-CoV-2 infection.
RESUMEN
Lumen-apposing metal stents (LAMSs) have been widely used for drainage of peripancreatic collections. A 71-year-old woman with a history of necrotizing pancreatitis who underwent LAMS placement 3 months ago for symptomatic pancreatic fluid collection presented with hematochezia and hemodynamic instability. Computed tomographic angiography of the abdomen showed concerns for stent erosion into the splenic artery. Esophagogastroduodenoscopy revealed a large pulsating nonbleeding vessel within the LAMS. She underwent a mesenteric angiogram, which showed splenic artery pseudoaneurysm, and coil embolization was performed. Gastrointestinal bleeding secondary to pseudoaneurysm should be considered in patients with recent LAMS placement who present with signs of gastrointestinal bleeding.