Mallory-Weiss syndrome — upper gastrointestinal bleeding from a mucosal tear at the gastroesophageal junction — requires careful management when the patient has a history of coronary artery disease. The cardiac comorbidity directly limits which hemostatic agents are safe to use, shifting the approach toward specific alternatives.
In patients with a history of coronary artery disease, epinephrine poses a particular risk: due to systemic absorption, it may cause ventricular tachycardia and should be avoided in this population. This constraint narrows the standard hemostatic options and necessitates a tailored management strategy.
When standard approaches are limited by the patient's cardiac history, management of Mallory-Weiss syndrome bleeding may involve angiographic intervention. The full structured protocol — specifying the interventional steps, target vessels, and technique options — is available via the link below.
DOI: 10.30574/gscarr.2025.23.3.0177
However, due to systemic absorption, epinephrine may cause ventricular tachycardia, so it should be avoided in patients with a history of coronary artery disease.
Angiographic interventions, such as injection of vasoconstrictor agents (e.g., vasopressin) or transcatheter embolization using gel foam, may be considered when endoscopy is unavailable or unsuccessful.
These approaches aim to obliterate the left gastric artery or superior mesenteric artery to control bleeding.
View source ↗