Managing Mallory-Weiss syndrome in patients with established coronary artery disease requires careful consideration of treatment selection, as certain standard interventions carry added cardiovascular risk in this population.
This protocol addresses Mallory-Weiss syndrome in the specific context of a patient with a history of coronary artery disease. The presence of this underlying cardiac condition directly influences which therapeutic options are safe and appropriate.
When earlier interventional options have been exhausted, surgery is considered as a last resort. The approach involves accessing and directly repairing the gastric laceration — either through an open abdominal procedure or a minimally invasive endoscopy-guided technique.
However, due to systemic absorption, epinephrine may cause ventricular tachycardia, so it should be avoided in patients with a history of coronary artery disease.
Surgery is rarely required and is considered a last resort following failed endoscopic or angiographic interventions.
If no duodenal or gastric lesions are found, a wide gastrostomy is performed via laparotomy.
Mallory-Weiss lacerations at the gastric cardia are readily visible and can be repaired using running catgut sutures.
Endoscopy-guided laparoscopic suturing of the tear has demonstrated excellent outcomes.
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