What are the common causes of rectal bleeding? Can IBS cause blood in stool? Get the answers to these questions and more in this informative article.

Understanding Rectal Bleeding: The Importance of Color

Rectal bleeding can be a concerning symptom, but the color of the blood can provide valuable clues about its origin. Bright red blood typically indicates bleeding from the lower colon or rectum, while dark red or maroon-colored blood suggests bleeding from higher up in the colon or small bowel. Black or dark-colored stool may be a sign of bleeding from the stomach.

It’s important to note that not all rectal bleeding is visible to the naked eye. In some cases, it can only be detected through medical testing. If you’re experiencing rectal bleeding, it’s crucial to consult with a gastroenterologist, such as Dr. Ian Martinez of Gastroenterology Services, who can properly diagnose and treat the underlying cause.

Common Causes of Rectal Bleeding

Rectal bleeding can be caused by a variety of conditions, ranging from minor to more serious. Some of the common causes include:

Hemorrhoids

Hemorrhoids, which are swollen veins in the anus or rectum, are the most common cause of rectal bleeding. They can be the result of chronic constipation or straining during bowel movements.

Anal Fissure

An anal fissure is a tear in the skin around the anus, often caused by the passage of hard stools. This can lead to a burning sensation during bowel movements.

Diverticulitis and Diverticulosis

Diverticuli are small pouches that can form in the intestines. If these pouches protrude through the intestinal wall and become infected, they can cause bleeding.

Irritable Bowel Syndrome (IBS)

While IBS is not typically associated with rectal bleeding, the condition can lead to bleeding due to the size and texture of the stool being passed. However, if the bleeding is significant, it may be a sign of a more serious underlying condition.

Colon Cancer

Colon cancer is one of the most serious causes of rectal bleeding and the third most common cancer in the United States. Polyps, which are mushroom-shaped growths on the lining of the colon, can also cause bleeding.

Inflammatory Bowel Diseases (IBD)

Conditions like Crohn’s disease and ulcerative colitis, which are types of inflammatory bowel disease (IBD), can lead to rectal bleeding due to the inflammation and ulceration of the digestive tract.

Ulcers

Ulcers, which are sores that can develop anywhere in the digestive tract from the stomach to the colon, can also cause bleeding that results in rectal bleeding.

Can IBS Cause Blood in Stool?

Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by abdominal discomfort and changes in bowel movements, but it does not typically cause blood in the stool. However, IBS symptoms such as constipation can lead to small tears in the anus, resulting in streaks of blood in the stool.

If you notice blood in your stool, it’s important to speak with a doctor, as it could be a sign of an underlying medical condition that requires proper diagnosis and treatment. While IBS may be a factor, other conditions, such as hemorrhoids, anal fissures, or even more serious conditions like colon cancer, should be ruled out.

Symptoms of IBS

The main symptoms of IBS include:

• Abdominal discomfort or pain
• Bloating and gas
• Changes in bowel movements, such as diarrhea, constipation, or both

These symptoms occur due to abnormal contractions of the intestinal muscles, which can be caused by a variety of factors, including abnormal signaling between the brain and the digestive system, as well as food intolerance.

Other Conditions That Can Cause Blood in Stool

While IBS is not a common cause of blood in the stool, there are several other medical conditions that can lead to this symptom, including:

Hemorrhoids

Swollen veins in the anus or rectum can cause rectal bleeding, especially during bowel movements.

Anal Fissures

Tears in the skin around the anus can lead to bleeding, often accompanied by a burning sensation during bowel movements.

Inflammatory Bowel Diseases (IBD)

Conditions like Crohn’s disease and ulcerative colitis can cause inflammation and ulceration in the digestive tract, leading to rectal bleeding.

Colon Polyps and Cancer

Growths on the lining of the colon, known as polyps, can bleed and contribute to rectal bleeding. In more serious cases, colon cancer can also be a cause of rectal bleeding.

Diverticulitis

Inflamed or infected pouches in the intestines, called diverticuli, can cause rectal bleeding.

Ulcers

Sores in the digestive tract, from the stomach to the colon, can bleed and result in rectal bleeding.

If you are experiencing rectal bleeding in Oviedo, FL, it’s essential to seek medical attention from a gastroenterologist like Dr. Ian Martinez of Gastroenterology Services. They can properly diagnose the underlying cause and recommend the appropriate treatment.

Causes of Rectal Bleeding

Rectal Bleeding

If you are suffering from rectal bleeding in Oviedo, FL, you may feel that you need to see a gastroenterologist. Dr. Ian Martinez of Gastroenterology Services specializes in just the sort of examinations that you require.

Blood Color

Having rectal bleeding can be very upsetting. It is important to know where the bleeding is coming from. The color of the blood gives your doctor a hint.

• Bright red usually means it originated in the lower colon or rectum
• Dark red or maroon color, meaning the blood comes from higher in the colon or the small bowel
• Black or dark stool can mean that the bleeding is in the stomach

But some rectal bleeding is not visible with the naked eye. It can only be detected through testing. Your gastroenterologist can test for rectal bleeding in Oviedo, FL. 

Causes of Rectal Bleeding

Many different conditions can cause rectal bleeding. Some are serious, others not so much. 

Hemorrhoids– Hemorrhoids are the most common cause of rectal bleeding. Swollen veins in the anus or rectum can be the result of chronic constipation or straining when you have a bowel movement. 

Anal Fissure-  An anal fissure is a tear in the skin around the anus. When you have a stool that is having a hard time passing, it can tear the skin. You may have a burning feeling when you have a bowel movement. 

Diverticulitis/Diverticulosis– Diverticuli are small pouches that occur in your intestines. If the pouches protrude through the wall of the intestine, they can become infected and cause bleeding.

IBS– Irritable Bowel Syndrome with Constipation can lead to rectal bleeding due to the size and texture of the fecal matter being passed. If it is large amounts of blood, it may be something else. 

Colon Cancer– Colon cancer is one of the most serious reasons for rectal bleeding and the third most common cancer in the US. Most colon cancer develops from polyps in the colon which are usually detected with a colonoscopy. 

Polyps-Polyps are shaped like a mushroom and grow on the lining of the colon. Large ones can bleed. 

IBD/Crohn’s and Ulcerative Colitis– Inflammatory Bowel Disease is two different conditions; Crohn’s Disease and Ulcerative Colitis. With Crohn’s Disease, the swelling can be anywhere in the digestive tract; with Ulcerative Colitis it is mostly in the large bowel. 

Ulcers-Ulcers are sores that can occur anywhere in the digestive tract from the stomach to the colon. These sores can bleed, causing bleeding from the rectum.  

If you are suffering from rectal bleeding in Oviedo, FL, Dr. Martinez of Gastroenterology Services can help figure out what is causing your rectal bleeding and recommend treatment. Call the office for an appointment at (407) 478-0882.

Can IBS cause blood in stools?

Key takeaways

• IBS is a gastrointestinal disorder characterized by abdominal discomfort and change in bowel movement
• IBS does not typically cause blood in stool. However, IBS symptoms such as constipation can cause small tears in the anus leading to streaks of blood in a person’s stool.
• Speak with a doctor if you notice blood in your stool, as other underlying medical conditions can cause it. 

Irritable bowel syndrome (IBS) is a condition that affects the gastrointestinal system. It is one of the most commonly diagnosed gastrointestinal disorders.

Blood in stool, also called rectal bleeding, is not commonly seen in people with IBS. However, it is possible. 

If you have IBS and notice blood in your stool, you may have a minor injury in your anal canal due to passing hard stools (constipation) or stooling frequently (diarrhea), which are both common symptoms of IBS.

In this article, we will discuss IBS, factors causing blood in stool in people with IBS, signs and symptoms of IBS, and some other medical conditions that can cause blood in the stool. 

What is Irritable bowel syndrome?

As the name implies, irritable bowel syndrome (IBS) is a group of symptoms that manifests when your intestine is ‘irritated. ’ It is a functional gastrointestinal disorder characterized by two major symptoms: abdominal discomfort (pain, bloating, fullness, and gas accumulation) and changes in bowel movements (diarrhea, constipation, or both). 

The symptoms occur due to abnormal contraction of the muscles of the GIT. When the contraction is weak and slow, it causes constipation, while diarrhea can occur when the contraction is strong and fast.

Health experts are not sure what causes IBS. However, some factors, such as abnormal intestinal muscle contraction, uncoordinated signals between the brain and the digestive system, and food intolerance, have been linked to it.

What causes blood in stool in people with IBS?

Factors that may cause blood in stool in people with IBS include:

• Anal fissure: This is a tear in the anal canal. Frequent passage of hard stools causes overextension of the canal and subsequent tear in the anus. Blood from the injury can appear as blood streaks on stools.
• Abrasions: They can also occur along the walls of the anal canal due to friction from constant stooling. This may result in traces of blood in stools. 
• Hemorrhoids: These are swollen veins in the rectum and anus. Frequent passage of hard stools and straining when stooling can cause the veins to swell (called hemorrhoids) and rupture. The ruptured hemorrhoids may cause blood in stools. Bleeding due to ruptured hemorrhoids is mostly seen in people with IBS-C.

Signs and Symptoms of IBS

The symptoms of IBS differ among individuals. It can range from mild to severe, but proper management can help relieve symptoms so they do not interfere with daily activities. The major symptoms of IBS include:

• Diarrhea
• Constipation
• Alternating diarrhea and constipation
• Abdominal pain
• Bloating
• Abdominal fullness
• Excess flatulence
• Food intolerance
• Fatigue
• Anxiety

Other medical conditions that can cause blood in stool

Studies have shown that blood in stool is one of the signs of impending health problems. Seeing blood in your stool indicates bleeding along the gastrointestinal tract. And if you have IBS, seeing blood in your stool may also mean you have another underlying medical condition.

Some other conditions that can cause blood in stool include:

Peptic ulcer

This is an open sore in the inner lining of the stomach and/or the upper part of the small intestine. When an ulcer occurs in the stomach, it is called a gastric or stomach ulcer, and when it occurs in the upper part of the small intestine, it is called a duodenal ulcer. Severe peptic ulcers can cause bleeding, which can be seen in stool as brown tarry stains.

Inflammatory bowel disease (IBD)

This is an autoimmune condition that causes inflammation and damage to the walls of the GIT. It is of two types: Crohn’s disease and ulcerative colitis. Both types of IBD can cause rectal bleeding.

Gastroenteritis

This is an infection of the gastrointestinal tract caused by a virus, bacterial, or parasite. This can cause damage to the walls of the tract resulting in rectal bleeding and blood in stools.

Polyps

These are benign growths on the lining of the digestive tract. Large polyps can cause rectal bleeding, which can be seen in stools.

Diverticulitis

This is a condition that occurs when small pouches develop on some part of the intestine. These pouches protrude through the walls of the intestine, causing bleeding.

Cancer

Cancer is the malignant growth of cells. Gastrointestinal malignancy causes growth in the lining of the tract and can result in bleeding in the GIT.

Is blood in the stool a cause for concern?

Blood in stool is one of the ‘alarm signs’ (signs indicating impending danger) of IBS and should be of utmost concern. It can be a sign of a minor injury in the gastrointestinal tract and can equally be a sign of severe health conditions, such as IBD or cancer. 

Early detection of these medical conditions helps make for a better outlook. Therefore, blood in stool is a good reason to go visit a primary care provider. If, after diagnosis, they find that you have a gastrointestinal condition, they may refer you to a gastroenterologist, a doctor that specializes in the treatment of gastrointestinal diseases. 

When to contact a doctor

Blood in the stool could be a result of a minor injury like an anal fissure and as well a sign of a more serious health condition. However, if you notice any trace of blood or large amounts of blood in your stool, you should consider seeing a doctor for a proper diagnosis to determine the major cause of the bleeding and commence treatment as soon as possible. 

This is especially necessary if the bleeding or blood in stool occurs for an extended period of time or is accompanied by other gastrointestinal symptoms.

Wrap up

Living with IBS can be burdensome for people with the condition, especially when the symptoms are severe and interfere with the activities of daily living. Nevertheless, following up with treatment and appointment dates with your doctor will help manage the condition. 

If you notice any sudden change in symptoms, such as worsening of the existing symptoms or development of new ones, e.g., rectal bleeding, you should consult your doctor as soon as possible for proper examinations and treatment.

Ischemic heart disease and anemia | Kirichenko A.A., Shatalova N.O., Grishin G.P., Fadeev A.M.

Coronary heart disease (CHD) is a pathology based on myocardial damage caused by insufficient blood supply. Atherosclerotic narrowing of the coronary arteries is the pathogenetic basis of coronary artery disease, but the development of myocardial ischemia requires an additional factor leading to an imbalance in the throughput of the coronary arteries and myocardial oxygen demand.

Most often, this is an increase in the work of the left ventricle (tachycardia, increased systolic blood pressure) or insufficiency of coronary blood flow (thrombus formation in the coronary arteries, spasm). Less often, as factors contributing to the development or progression of IHD, a decrease in perfusion pressure (DBP) or a violation of the oxygen transport function of the blood, etc.

are considered.
For clarity, we present extracts from the case histories of patients in whom these factors played the role of a “triggering mechanism”. The opinion that it is customary to wear pants only for men, and women should be sophisticated and elegant, preferring skirts and dresses, is absolutely not relevant at the present time.

Clinical case 1

Patient Sh., 84 years old, was hospitalized in May 2013 with complaints of pressing pain behind the sternum with little physical exertion and at rest.

For more than 30 years, high blood pressure numbers (up to 200/120 mm Hg), type 2 diabetes mellitus have been recorded.

4 months ago suffered an acute myocardial infarction without a Q wave of the lateral wall of the left ventricle. With coronary angiography: the anterior interventricular branch (ALV) of the left coronary artery (LCA) was stenotic in the proximal third by 50%, in the distal third — successive stenoses of 30–50%; the circumflex artery (OA) is stenotic in the middle third by 70%, the right coronary artery (RCA) is suboccluded in the anterior third, occluded in the middle third, the distal part is poorly contrasted by inter- and intra-arterial anastomoses. Stenting of the middle third of the OA was performed. RCA recanalization failed.

Attention was drawn to the presence of mild hypochromic anemia (hemoglobin -106 g/l). An examination of a possible source of bleeding did not reveal. He was discharged in a satisfactory condition with a recommendation to take acetylsalicylic acid and clopidogrel, hypoglycemic therapy, and iron supplements.

At home, he took the recommended drugs irregularly, did not visit the doctor.

About 2 months ago noted an increase in weakness. Rare bouts of retrosternal pain began to bother me. On the ECG dated May 10, 2013: against the background of sinus rhythm with a heart rate of 75 bpm, there is a pronounced depression of the ST segment in leads V2-6 (Fig. 1). He refused the offered hospitalization.

Last 2 weeks attacks of retrosternal pain of a pressing nature became more frequent, they began to occur with minimal physical exertion and at rest, sublingual nitroglycerin had a short-term effect, a feeling of lack of air appeared. He turned to the clinic, from where he was taken to the Central Clinical Hospital with a diagnosis of coronary artery disease, progressive angina pectoris.

On admission: pale skin. There are no edema. BH – 18 in 1 min. Breathing is hard. Pulse – 72, BP – 140/70 mm Hg. Art. on both hands. Systolic murmur at Botkin’s point and at the apex, conducted to the left axillary region.

ECG at admission (Fig. 2): sinus rhythm with a heart rate of 59 bpm, atrioventricular conduction delay (PQ – 0.24 s). Slow conduction in the left atrium and ventricle. Left ventricular hypertrophy. Violation of repolarization in V2-5.

EchoCG: LV myocardial hypertrophy (LVML – 240 g). Thickening of the interventricular septum (IVS), more pronounced in the basal part (1.6–1.8 cm), without signs of LV outflow obstruction. The thickness of the LVW is 1.5 cm. The contractility of the LV myocardium is satisfactory (EF according to Teicholz is 63%), the CSR is 3.6 cm, the CDR is 5.5 cm, the LA is 5. 1 cm. No zones of impaired kinetics were identified. Change in LV diastolic function of the first type.

Coronary angiography (CAG) was urgently performed (Fig. 3): the LCA trunk was not changed. The LAD is stenotic at the border of the anterior and middle thirds by 50%, along the distal third there are successive stenoses of 30–60%. 1DV — anatomically small, stenotic at the mouth by 80%, occluded in the middle third, the distal part is poorly contrasted by interarterial collaterals. VTK is stenotic at the mouth up to 50%. OV is anatomically large, passable throughout, previously implanted stents are without stenotic changes. The RCA is suboccluded in the anterior third, occluded in the middle third, the distal part is poorly contrasted by inter- and intra-arterial anastomoses. Balanced type of coronary blood supply.

Given the lack of dynamics of coronary artery stenoses compared to CAG in January 2013, percutaneous coronary intervention was not performed.

In the blood test: hemoglobin – 61 g / l, erythrocytes – 2. 30 × 10 * 12, CP – 0.8, hematocrit – 18.5, leukocytes – 7.7 × 10 * 9.

Cardiospecific enzymes (CPK MB, troponin T) were within the reference values.

In the analysis of urine: specific gravity – 1020, protein – 0.15, leukocytes – 0-5 in the field of view, erythrocytes – 100-150 in the field of view.

An additional targeted questioning made it possible to find out that over the past 4 months. there were repeated episodes of dark red urine, sometimes lasting for several days (gross hematuria?).

There was no convincing evidence of acute focal myocardial damage at the time of hospitalization. Given the presence of severe anemia, a transfusion of washed erythrocytes (1150 ml per 2 days) was performed with a positive effect: the hemoglobin level increased to 100 g/l, the number of erythrocytes – up to 3.59×10*12, hematocrit — up to 29.4.

On the ECG, 1 day after the last blood transfusion, normalization of the final part of the ventricular complexes in the chest leads is noted (in V4, the T wave is weakly negative).

The patient’s well-being improved significantly: over the next 3 days, with the expansion of the motor regimen to the level of physical activity corresponding to the 3rd functional class, there was no pain in the chest, the severity of dyspnea significantly decreased, the volume of loads was limited mainly by muscle fatigue. Episodes of gross hematuria did not recur. In a satisfactory condition, the patient was transferred for additional examination to the urological department.

Clinical case 2

Patient K., 50 years old, was hospitalized in December 2014 with progression of angina pectoris, dyspnea that occurs with minimal physical exertion, at rest, with an increase in general weakness during the last month.

Past medical history: AH with maximum known BP values ​​of 200/100 mm Hg. Art. more than 15 years old; regularly takes antihypertensive drugs, but blood pressure control is irregular. In 2002, he suffered an AMI, in the same year, coronary artery bypass grafting (CABG) was performed on the LAD, RCA, OA. In 2009the clinic of progressive angina pectoris developed, in connection with which the stenting of the shunt to the LCA was performed. In May 2014 – repeated AMI of the posterior wall of the left ventricle, systemic thrombolysis, percutaneous coronary intervention with recanalization and stenting of CABG to OA were performed. After discharge and until the present hospitalization, the patient’s condition is stable.

Concomitant diseases: type 2 diabetes mellitus, urolithiasis, chronic hemorrhoids, mild iron deficiency anemia has been recorded since 2009(did not take iron preparations).

On admission: the skin is pale, dry. BH – 18 beats / min. Breathing is hard, a small amount of wheezing on exhalation. Heart sounds are muffled. Heart rate -76 bpm. BP – 150/90 mm Hg. Art. on both hands.

The ECG was recorded against the background of a pain attack (Fig. 4): sinus rhythm, heart rate – 88 bpm, ST segment upward displacement from the isoline in leads III, aVF, V1. In leads I and aVL, the shift of the ST segment downwards from the isoline. Q wave lasting 0.04 s in II, III, aVF leads.

Echocardiography: LV myocardial hypertrophy (LVML – 213 g, IVS – 1.5 cm, ZSLV – 1.2 cm). Dilatation of the left atrium (5.3×6.1 cm). Violation of the diastolic function of the left ventricle of the first type. Hypokinesis of diaphragmatic, posterobasal and posterolateral segments. EF – 54% according to Teicholz.

In the general blood test: hemoglobin – 70 g / l, erythrocytes – 4.29 × 10 * 12, hematocrit -23.5, CP – 0.48, hypochromia, anisocytosis, poikilocytosis (ovalocytes, target erythrocytes), leukocytes – 5, 9×10*9. Serum iron – 1.9.

Cardiospecific enzymes (CPK MB, troponin T) were within the reference values.

Thus, there was no convincing evidence of acute focal myocardial damage at the time of hospitalization. It has been suggested that the cause of angina progression was severe iron deficiency anemia, most likely post-hemorrhagic. A transfusion of 630 ml of erythrocyte suspension was performed on the first day, parenteral administration of iron preparations was started.

Transfusion therapy was well tolerated. Anginal pain did not recur. On the ECG recorded after blood transfusion (Fig. 5): heart rate – 62 bpm. The ST segment returned to the isoline.

In the blood test after 1 day: the hemoglobin level increased to 105 g/l, the number of erythrocytes – up to 5.71 × 10 * 12, hematocrit – 38.3, CP – 0.55, hypochromia, anisocytosis persist. Leukocytes – 8 × 10 * 9.

The patient was in the ICU for 3 days, antianginal therapy was not required, since angina attacks did not recur.

A search for a possible source of blood loss was carried out, oncological search: colonoscopy revealed chronic combined hemorrhoids of the 3rd degree. No other pathology that could explain the presence of anemia was found.

A gradual expansion of the motor mode was carried out. Physical activity corresponding to the level of functional class 3 does not cause angina attacks and ECG signs of myocardial ischemia.

After 12 days in a stable condition, the patient was discharged for further treatment on an outpatient basis. The surgeon recommended the planned desarterization of hemorrhoids under ultrasound guidance.

Clinical case 3

Patient Z., 82 years old, was hospitalized with complaints of discomfort behind the sternum, lack of air, arising without a clear connection with physical activity, lasting up to 4-5 minutes, the day before there was a protracted attack lasting more than 1 hour, severe weakness, sweating. A real deterioration in the condition has been noted during the last 3 days against the background of hypotension that has appeared.

Within 2 weeks before hospitalization, he took non-steroidal anti-inflammatory drugs (NSAIDs) (ketorolac) for dorsalgia. 4 days ago, he noted the appearance of rapid liquid stools of dark color, unusually low blood pressure – 80/40 mm Hg. Art.

In 1995, he suffered an AMI of the inferior LV wall. In the same year, mammary-coronary bypass grafting of the LAD, CABG of the PBV OA and RCA was performed. In 2003 – linear aortofemoral bypass with a synthetic prosthesis on the left. The early postoperative period was complicated by the development of repeated AMI of the inferior LV wall.

Since 2009 – paroxysms of atrial tachyarrhythmia.

Constantly taking bisoprolol — 2.5 mg/day, perindopril — 5 mg/day, atorvastatin — 20 mg/day, warfarin — 5 mg/day. INR control was not carried out for more than a year.

On admission: the skin and visible mucous membranes are pale. The number of breaths is 20 per 1 min. Breathing is weak, hard. Heart sounds are deaf, rhythmic. Heart rate – 76 beats / min. BP – 110/70 mm Hg. Art.

Laboratory data: hemoglobin – 91 g / l, erythrocytes – 3.93 × 10 * 12, hematocrit – 33.0, CP – 0.84, leukocytes – 10.2–10.6 × 10 * 9, platelets – 223 × 10*9, anisocytosis, anisochromia.

Cardiospecific enzymes: CPK — 268 on admission, after 10 hours — 319, CPK MB – 30 at admission, after 10 hours – 42, troponin T at admission – 177, after 10 hours – 538.

Serum iron – 13 µmol, iron transport proteins within the normal range. Coagulogram: APTT – no coagulation, INR – no coagulation, fibrinogen – 3.3 g/l, D-dimer – 1147.

ECG (Fig. 6) on admission: sinus rhythm, stage 1 AV block, cicatricial changes in the inferior LV wall, ST segment shift in leads II, III and avF, high R in V1-2. ECG archive not provided.

Echocardiography: sclerosis and calcification of the aortic walls, annulus and cusps of the aortic valve. LVML – 204 g, IVS thickness – 1.0 cm, ZLV – 1.0 cm. Dilatation of the left heart (LA – 4.5 × 5.5 cm, left ventricle: ESR – 92, EDV – 171). Relative insufficiency of MK II degree. Hypokinesis of the middle posterior and posterolateral LV segments. Decreased global contractility of the LV myocardium (EF according to Teicholz – 47%). Diastolic dysfunction of the left ventricle of the first type.

Taking into account complaints, anamnesis, laboratory and instrumental data, the patient was diagnosed with repeated AMI of diaphragmatic and posterior basal localization.

Gastrointestinal bleeding that occurred while taking NSAIDs and an oral anticoagulant was not ruled out, in connection with which EGDS was urgently performed: endoscopic signs of chronic esophagitis, ulcer of the lower third of the esophagus Forrest II C. Acute gastric ulcer Forrest II B (without signs of ongoing bleeding). Pyloric ulcer Forrest I B (with signs of ongoing bleeding). After endoscopic injection hemostasis, the bleeding was stopped.

The cause of AMI was probably hypotension and anemia on the background of gastrointestinal bleeding. Started conservative hemostatic, antiulcer therapy. It was decided to refrain from performing CAG with possible percutaneous coronary intervention until the condition stabilizes.

During treatment, blood pressure figures stabilized at 120/85 mm Hg. Art., hemoglobin level increased to 110 g / l, the number of erythrocytes increased – up to 5.71 × 10 * 12, hematocrit – 38.3, CP – 0.55, leukocytes – 8 × 10 * 9, hypochromia, anisocytosis persist.

The level of CPK activity decreased to 113 units, CPK MV – to 12.7, troponin T – to 225.

Endoscopy after 2 days: ulcer of the lower third of the esophagus Forrest III, acute gastric ulcer Forrest III, pylorus ulcer Forrest II C (no signs of bleeding, appearance of fibrin in the bottom area).

On the 3rd day of stay in the hospital, short-term attacks of compressive pain behind the sternum resumed (2 attacks: during meals and when trying to sit up in bed).

According to urgent indications, coronary angiography was performed (Fig. 7): the LCA trunk was stenotic in the anterior and middle third up to 70%, suboccluded in the distal third with the transition to the mouths of the OB and LAD; The LAD is suboccluded at the orifice, 80% stenotic in the anterior third, occluded in the middle third, the distal part is contrasted by a functioning mammary-coronary bypass graft. OB is suboccluded at the mouth, stenotic in the anterior third by 80%; The RCA is suboccluded along the anterior and middle thirds, occluded at the border of the middle and distal thirds, the distal part is contrasted by interarterial anastomoses.

Right type of coronary blood supply.

The mammary-coronary bypass from the right mammary artery in the distal third of the LAD is passable. Shunts to OA and RCA are not visualized.

An attempt to recanalize stenotic arteries was unsuccessful due to severe calcification.

Over the next day, a state with negative dynamics: in the form of an increase in short-term angina attacks, accompanied by pronounced ECG signs of myocardial ischemia (Fig. 8). A decrease in hemoglobin from 110 to 87 g/l, hematocrit to 26.0 was noted.

Cardiospecific enzymes within normal limits. Echocardiography: the size of the left parts of the heart is the same, no new areas of LV wall motion disorder were detected.