Treatment of Mallory-Weiss Syndrome in Patients with History of Coronary Artery Disease
Clinical scenario
This protocol addresses Mallory-Weiss syndrome (ICD DA26.3) in the specific setting of a patient with a
history of coronary artery disease.
The cardiac comorbidity has direct implications for which interventions are appropriate, and the protocol is structured accordingly.
Why coronary artery disease matters here
Certain agents used in the management of upper GI bleeding carry cardiovascular risk in patients with a history of coronary artery disease.
Due to systemic absorption, some pharmacologic options may cause cardiac arrhythmia and should be avoided in this population.
The protocol is specifically shaped to account for this constraint.
Approach — partial overview
Initial management centres on immediate hemodynamic resuscitation following ABC principles, with establishment of intravenous access and fluid resuscitation.
Pharmacologic support to reduce gastric acidity and control nausea forms part of the stabilisation strategy — with agent selection adapted to the patient's cardiac history.
Full sequencing, complete cardiac-specific considerations, and all management steps are available via the structured regimen below…
Clinical goals
Hemostasis achieved and resolution of symptoms.
References
- Immediate resuscitation is necessary for patients presenting with active bleeding upon admission.
- Hemodynamic stability should be assessed through airway, breathing, and circulation (ABC) protocols.
- Establishing good central or peripheral intravenous (IV) access (preferably two lines) alongside fluid resuscitation is crucial and may be lifesaving in cases of massive hemorrhage.
- Proton pump inhibitors (PPIs) and H2 receptor antagonists are administered to reduce gastric acidity, as increased acidity impairs mucosal healing of the stomach and esophagus.
- Additionally, antiemetics such as promethazine and ondansetron may be used to control nausea and vomiting.
- However, due to systemic absorption, epinephrine may cause ventricular tachycardia, so it should be avoided in patients with a history of coronary artery disease.
DOI: 10.30574/gscarr.2025.23.3.0177
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