Diarrhea in a Patient With a History of Acute Coronary Syndrome

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Background

A 50-year-old man presents with 6-month history of chronic diarrhea. The patient has two to three motions per day; stool is loose in consistency and sometimes, light in color.

The patient has hypertension controlled on enalapril 20 mg/d. Eight months ago, he had an acute coronary syndrome and was admitted to the cardiac intensive care unit. He is now on anti-ischemic medications (ie, aspirin, an angiotensin-converting enzyme receptor inhibitor, statins, and nitrates) and the proton pump inhibitor (PPI) pantoprazole. The patient is stable on the aforementioned medications, with occasional angina on exertion or stress that is relieved by sublingual nitrates as needed.

He has also had a mild pruritic rash intermittently for the past 6 months, which he has managed with topical lotions and antihistamines.

The patient reports a history of heavy tobacco smoking (one pack per day) and drinking (30 units per week) from age 25 years up until 8 months ago. He was found to have a duodenal ulcer 4 years ago (Figure 1), which is now healing. Since his cardiac incident, he stopped smoking and abstained from alcohol completely.

He does not report rectal bleeding, abdominal pain, vomiting, fever, recent antibiotic use, prior colonoscopy, family history of colon cancer, unintentional weight loss, fecal urgency, or nocturnal stooling.

His primary physician requested multiple stool analyses, which were unremarkable. The patient will be scheduled for colonoscopy for luminal examination.

Figure 1. Upper gastrointestinal endoscopy showing prior large nonbleeding duodenal ulcer.

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Sarah El-Nakeep. Diarrhea in a Patient With a History of Acute Coronary Syndrome - Medscape - Jun 28, 2024.

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