Abstract
A 68-year-old man with advanced gastric cancer was admitted to our hospital for the treatment of acute myocardial infarction. Bradycardia and hypotension occurred, and we started temporary right ventricular pacing and intra-aortic balloon counterpulsation in addition to high-dose catecholamine. Intravenous thrombolysis was contraindicated because of gastric cancer with active bleeding, so we performed emergent coronary angiography. Coronary angiography showed total occlusion with large thrombi in the right coronary artery and left anterior descending coronary artery. Coronary revascularization could not be achieved, but subtotal gastrectomy was performed on hospital day 51. Preoperative laboratory data showed evidence of a hypercoagulable state and increased fibrinolysis, but these abnormalities improved after gastrectomy. We conclude that gastric cancer caused a hypercoagulable state, resulting in acute myocardial infarction with simultaneous occlusion of two main coronary arteries in this case.
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