TY - JOUR
T1 - Cholecystitis masquerading as cardiac chest pain
T2 - A case report
AU - Daliparty, Vasudev Malik
AU - Amoozgar, Behzad
AU - Razzeto, Alejandra
AU - Ehsanullah, Syed Usman Mohsin
AU - Rehman, Faseeha
N1 - Publisher Copyright:
© Am J Case Rep, 2021.
PY - 2021
Y1 - 2021
N2 - Background: Cope’s sign is the association of bradycardia with symptoms of acute cholecystitis, which can occur due to a vagal cardiobiliary reflex. The clinical and electrocardiographic changes of bradycardia or complete heart block can mimic the presentation of acute coronary syndrome. This report highlights the unique possibility that bra-dycardia in patients with abdominal pain and gallstones can be due to this reflex. A 46-year-old obese man with hyperlipidemia and gallstones presented with chest pain suggestive of cardiac ischemia. The initial electrocardiography (EKG) was normal, although the patient subsequently developed bradycardia and a 2nd-degree atrioventricular (AV) block. The results of further cardiothoracic investigations (including echocardiography and pharmacologic stress testing) were normal. An ultrasound of the abdomen revealed acute cholecystitis. After he underwent a laparoscopic cholecystectomy, the chest pain resolved com-pletely, and the EKG reverted to its normal sinus rhythm. Acute cholecystitis rarely presents with cardiac chest pain and EKG changes due to triggering of the vagal car-diobiliary reflex. Given this atypical presentation, patients often undergo invasive cardiac procedures in search of a nonexistent cardiac etiology coupled with the possibility of a missed diagnosis of cholecystitis. When cli-nicians consider a diagnosis of acute coronary syndrome in patients with bradycardia, T-wave inversion, and ST-segment elevation (especially in the inferior leads), they should add the possibility of intra-abdominal pa-thologies (including cholecystitis) in the differential diagnosis.
AB - Background: Cope’s sign is the association of bradycardia with symptoms of acute cholecystitis, which can occur due to a vagal cardiobiliary reflex. The clinical and electrocardiographic changes of bradycardia or complete heart block can mimic the presentation of acute coronary syndrome. This report highlights the unique possibility that bra-dycardia in patients with abdominal pain and gallstones can be due to this reflex. A 46-year-old obese man with hyperlipidemia and gallstones presented with chest pain suggestive of cardiac ischemia. The initial electrocardiography (EKG) was normal, although the patient subsequently developed bradycardia and a 2nd-degree atrioventricular (AV) block. The results of further cardiothoracic investigations (including echocardiography and pharmacologic stress testing) were normal. An ultrasound of the abdomen revealed acute cholecystitis. After he underwent a laparoscopic cholecystectomy, the chest pain resolved com-pletely, and the EKG reverted to its normal sinus rhythm. Acute cholecystitis rarely presents with cardiac chest pain and EKG changes due to triggering of the vagal car-diobiliary reflex. Given this atypical presentation, patients often undergo invasive cardiac procedures in search of a nonexistent cardiac etiology coupled with the possibility of a missed diagnosis of cholecystitis. When cli-nicians consider a diagnosis of acute coronary syndrome in patients with bradycardia, T-wave inversion, and ST-segment elevation (especially in the inferior leads), they should add the possibility of intra-abdominal pa-thologies (including cholecystitis) in the differential diagnosis.
KW - Acute Coronary Syndrome
KW - Chest Pain
KW - Cholecystitis
UR - http://www.scopus.com/inward/record.url?scp=85115429200&partnerID=8YFLogxK
U2 - 10.12659/AJCR.932078
DO - 10.12659/AJCR.932078
M3 - Article
C2 - 34548467
AN - SCOPUS:85115429200
SN - 1941-5923
VL - 22
JO - American Journal of Case Reports
JF - American Journal of Case Reports
IS - 1
M1 - e932078
ER -