CONCOMITANT ULCER PERFORATION AND ACUTE M YOCARDIAL-INFARCTION IN A PATIENT - AN EMERGENCY DIAGNOSTIC CHALLENGE

Clinical differentiation between acute myocardial infarction and pepti c ulcer perforation may sometimes be difficult. We report on a sixty-f ive year-old patient who presented at the Emergency Department with up per abdominal pain and local tenderness suggestive of acute perforatio n of a gastric ulcer. However, the initial electrocardiogram (ECG) sho wed acute inferior wall myocardial infarction. Although abdominal pain is a major symptom of acute inferior wall myocardial infarction the h istory of gastritis abdominal findings on admission of our patient req uired further exploration. The first plain abdominal radiograph was in conspicuous, therefore we performed a gastroscopy, which showed a prep yloric gastric ulcer. The second plain abdominal radiograph revealed a ir in the peritoneal cavity as sign of perforation. Echocardiography, ECG and the increase of heart enzymes confirmed acute inferior wall in farction. After successful surgical treatment of the perforated ulcer the patient recovered and progressed satisfactorily at the intensive c are unit. He was discharged after three weeks and remains in good heal th. This case shows that rapid diagnosis and good interdisciplinary th erapeutic management prevented a fatal outcome of acute myocardial inf arction and concomitant gastric ulcer perforation in an elderly patien t.