1. Russian Scientific Society of Cardiology 1st Vice-president
Gastroenterological problems in cardiac patients with coronary heart disease Clinical situations
Professor Yury Pozdnyakov
Russian Scientific Society of Cardiology 1st Vice-president

2. Coronary disease and surgical pathology
Combination of clinical manifestations of coronary heart disease and acute surgical pathology (acute cholecystitis, pancreatitis, perforated gastric ulcer and duodenal ulcer)
Pain syndrome localized in the epigastrium in patients with inferior myocardial infarction (unwarranted laparotomy and laparoscopy)
Myocardial infarction and mesenteric vascular thrombosis
Myocardial infarction and erosive gastritis, peptic ulcer with acute bleeding

3. Coronary disease and diseases of the thoracic and abdominal cavities
Gastro-esophageal reflux disease (GERD) is damage to the mucosa of the esophagus induced by stomach contents
Clinical signs
Heartburn
Pain behind the sternum (not relieved by nitroglycerine): occurs at rest, after eating, when bending
pain mimics heart attack, but not irradiating to the neck and teeth
ECG unchanged in pains
Troponin test is negative
Necessary tests:
Esophagogastroduodenoscopy or barium X-ray
Further tests:
Echocardiography, Holter monitoring, stress tests

4. Hiatal hernia
Hiatal hernia is the penetration of the stomach into the chest cavity through the oesophageal hiatum
Patient complaints:
Epigastric pain and lower part of sternum, pain gets worse in the supine position
Pains significantly aggravates with hernia incarceration and simulate a myocardial infarction
Findings:
ECG - normal
Troponin test is negative
With X-ray study revealed additional formation
in the mediastinum. This requires urgent
surgical intervention

5. Acute cholecystitis Findings:
Acute cholecystitis is inflammation of the gall bladder due to duct obstruction by stone and infection
Findings:
ECG: modified segments ST and negative T (cholecysto-coronary syndrome)
Study, which is necessary to
ECG in the dynamics
Troponin test
Laboratory markers of inflammation
Liver enzyme tests
Enzymes
Patients should be monitored by a surgeon and
cardiologist

6. Acute pancreatitis
Patient complaints
A pain in the epigastric and umbilical region radiating to the sternum area and interblades zone, ↓ AP.
Differential diagnosis with myocardial infarction and dissecting aneurysm of the abdominal aorta
Findings:
complete blood count, dynamics of Hb and Ht
ECG: nonspecific changes ST and Т
Troponin test is negative

7. Acute mediastinitis Etiology:
Acute mediastinitis simulates an acute coronary attack
Etiology:
The reason is a perforation of the esophagus either spontaneously or during esophagogastroduodenoscopy
Clinical signs:
retrosternal pain with fever, leukocytosis and  ESR
Findings:
ECG - normal
Troponin test is negative
Echocardiography to identify signs of fluid
in the mediastinum
Treatment Surgery

8. Erosive-ulcerative esophagitis Cancer of the esophagus
Clinical signs:
patient can be treated like in coronary heart disease, because pain syndrome is similar to anginal
Findings:
an esophagogastroduodenoscopy at an early stage helps clarify the diagnosis of lesions of the esophagus

9. Thank you for your attention!