Cardiovascular manifestations of acute pancreatitis.

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas that is associated with variable involvement of pancreatic/peripancreatic tissue and one or more organ systems in varying degrees. Among the multiple organ system dysfunctions in severe AP, cardiovascular and/or pulmonary manifestations are frequent. The cardiovascular system may be affected alone or with other organ systems in all stages of AP. Abnormalities of cardiac rhythm, contractility, and vasomotor tone of peripheral vessels are common cardiovascular manifestations. The pathogenetic factors of cardiac manifestations include hypovolemia and metabolic disturbances (eg, hyperkalemia, hypomagnesemia, and hypophosphatemia). Clinically, patients present with hypotension, tachycardia, and signs of systemic inflammatory response syndrome (high cardiac index, significant pulmonary shunting, decreased systemic vascular resistance, and decreased myocardial contractility). Approximately 50% of patients with AP have electrocardiographic changes, most commonly T-wave flattening and ST-segment depression. Many of the cardiac manifestations in AP are reversible with appropriate management. In AP, early onset of either multi-organ dysfunction or a sustained single-organ dysfunction is associated with poor outcome. This review highlights cardiac manifestations of AP relevant to clinical practice.