An Uncommon Presentation of Acute MI

I wish to add ileus to the list of atypical presenting symptoms of acute myocardial infarction (MI) in an article by Drs William J. Brady, Jr, Andrew D. Perron, and Chris A. Ghaemmaghami (CONSULTANT, July 2001, page 1153). Two of my patients in whom ECG changes characteristic of acute posterior-wall MI developed initially presented with gradually progressive paralytic ileus, abdominal distension, and poor-to-absent bowel sounds. They also had a sense of anxiety and vague distress. One patient had a temperature of 38.3^oC (101^oF); the other was afebrile.
—Gabriel A. Covo, MD
  New York
I have also encountered patients with abdominal distention, ileus, and acute MI in my practice. They are usually elderly and present with altered mentation and a range of clinical abnormalities, including GI atony.
I have found few descriptions, however, of such a presentation for acute MI in the literature. A recent report describes a 65-year-old man with chest pain, abnormal ECG findings, and ileus.¹ Other papers from the 1960s report an association between ileus and acute MI-either as a presenting sign² or as a noncardiovascular complication that developed after admission for acute MI.³
It would be rare for an ileus to be the sole presenting symptom of acute MI. An elderly patient who presents with a change in mental status may be experiencing acute MI as either the cause of the presenting symptoms or a complication of the responsible illness. An ileus certainly would be a feature of such a presentation-but not the sole clinical issue.
—William J. Brady, Jr, MD
  Associate Professor of Emergency Medicine and
  Internal Medicine
  Director, Emergency Medicine Residency Program
  Vice-Chairman of Emergency Medicine
  University of Virginia School of Medicine
  Charlottesville