Acute coronary syndrome mimicked by acute cholecystitis

Aksay, Ersin; Ersel, Murat; Kıyan, Selahattin; Musalar, Ekrem; Güngör, Hasan

doi:10.1111/j.1742-6723.2010.01291.x

Cited by 13 publications

(16 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In previous studies, gallbladder distension has been associated with nonspecific T-wave inversions or ST segment depressions that are similar to those of ischemic heart disease [1, 2, 3, 4], and only five previous cases with similar ischemic ECG changes attributed to cholecystitis have been reported [5, 6, 7, 8, 9]. Several studies in animals [10, 11] have demonstrated that gallbladder distension can reduce coronary blood flow and increase heart rate and arterial blood pressure, and may explain the association with transiently mimicked myocardial ischemia and ST segment ECG changes.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic Changes and False-Positive Troponin I in a Patient with Acute Cholecystitis

Demarchi

Regusci²,

Fasolini³

2012

Case Rep Gastroenterol

View full text Add to dashboard Cite

Cardiac troponins are the most sensitive and specific serum markers of myocardial cell injury, but they can also arise without apparent cardiac injury. Besides, acute cholecystitis may be associated with nonspecific ST-T wave changes in electrocardiography (ECG). The signs and symptoms of gallbladder and heart disease may overlap, which can make diagnosis difficult. We describe the case of a 75-year-old woman with clinical features suggestive of acute cholecystitis associated with transient ST segment elevation and elevated troponin I that, after extensive workup, did not seem to be attributable to myocardial ischemia or any other acute cardiac problem, but were exclusively related to cholecystitis. We show that cholecystitis with gallbladder distension can be the sole cause of pathological ECG changes and an increased troponin I level; this should be considered when evaluating patients with similar presentations.

show abstract

Section: Discussionmentioning

confidence: 99%

Electrocardiographic Changes and False-Positive Troponin I in a Patient with Acute Cholecystitis

Demarchi

Regusci²,

Fasolini³

2012

Case Rep Gastroenterol

View full text Add to dashboard Cite

show abstract

“…Visceral-cardiac reflex secondary to gastric distention which causes increased vagal tone can lead to ECG changes. Symmetrical T-wave inversions in patients with biliary pathology have been explained using this concept in several case reports [3, 4]. The increased vagal tone may also cause transient coronary vasospasm.…”

Section: Discussionmentioning

confidence: 99%

Gastric dilatation and intestinal obstruction mimicking acute coronary syndrome with dynamic electrocardiographic changes

Herath

Matthias

Keragala

et al. 2016

BMC Cardiovasc Disord

View full text Add to dashboard Cite

BackgroundST elevation myocardial infarction is a medical emergency and the electrocardiogram is a part of the mainstay in the initial diagnosis. A variety of non-cardiac conditions have been known to mimic the electrocardiographic changes seen in acute coronary syndrome. We present a patient presenting with acute partial intestinal obstruction causing gastric distension and intestinal dilatation who also had dynamic electrocardiographic changes, mimicking anterior ST elevation myocardial infarction. Only very few cases of gastric distention and intestinal dilatation leading to acute ST segment elevation in electrocardiogram are reported so far in literature.Case presentationA fifty-six-year-old Sri Lankan male, without any modifiable risk factors for ischemic heart disease presented with acute onset nausea, vomiting, sweating, abdominal discomfort and fullness without any chest pain. On examination, he had a pulse rate of 50 beats per minute and his blood pressure was 110/50 mmHg. His abdomen was distended and the liver dullness was not detectable. Subsequent ECG showed > 2 mm ST elevations with T inversions in chest leads V1 to V3, J point elevation in leads L 11, L 111, aVF and T inversion in leads L 1 and aVL. Cardiac biomarkers were normal and 2D echo showed normal left ventricular function without any regional wall motion abnormalities. Abdominal X-ray showed a distended stomach, dilated ascending and descending colon with absent rectal air. Electrocardiographic changes reverted back to normal with the resolution of bowel obstruction.ConclusionThe mechanism of ECG changes in such a case like this is yet to be elucidated, but can be postulated to happen due to change in the position of the heart in the thoracic cavity causing change in the cardiac axis. This case emphasizes the importance of a proper history and highlights the value of auxiliary investigations such as cardiac biomarkers and echocardiogram in the diagnosis of acute coronary syndrome in a confusing situation such as this. This also illustrates the importance of early recognition of other noncardiac causes like acute gastric distention as being responsible for dynamic ECG changes. This will obviate a myriad of unnecessary investigations, interventions, costly management strategies and patient anxiety.

show abstract

“…It is well known that not only chest symptoms but also ECG changes suggestive of myocardial ischemia might be present in patients with cholecystitis, such as T-wave inversion, ST segment depression, and ST segment elevation [2, 10]. In addition to their confusing symptoms and ECG changes, H-FABP—a biochemical diagnostic marker in the early phase of acute myocardial infarction [11]—was positive in three (75 %) of four patients who were initially suspected to have acute coronary syndrome in group 1.…”

Section: Discussionmentioning

confidence: 99%

“…First, distention of the bile duct may actually reduce the coronary artery flow [16, 17]. Second, there may be a coronary vasospasm that is caused by a vagally mediated reflex [2]. ECG changes may also be evoked in response to inflammation of other visceral organs; for instance, Rubio-Tapia reported that more than half of their study patients with acute pancreatitis showed certain ECG abnormalities, some of which might reflect electrolyte alterations and dehydration [18].…”

Section: Discussionmentioning

confidence: 99%

Acute cholecystitis mimicking or accompanying cardiovascular disease among Japanese patients hospitalized in a Cardiology Department

et al. 2015

View full text Add to dashboard Cite

BackgroundAcute cholecystitis sometimes displays symptoms and electrocardiographic changes mimicking cardiovascular problems. It may also coexist with cardiovascular disorders. We analyzed the clinical characteristic of the cardiac patients who were diagnosed with acute cholecystitis during hospitalization in the cardiology department.MethodsUsing the department database, we identified 16 patients who were diagnosed with acute cholecystitis during the hospitalization in the cardiology department between June 2010 and June 2014.ResultsFive patients who were initially suspected to have cardiac problems (acute coronary syndrome, four patients; Adams-Stokes syndrome, one patient) owing to their symptoms were subsequently diagnosed with acute cholecystitis. Two of these patients showed electrocardiographic changes mimicking myocardial ischemia, and three tested positive for a biomarker (heart-type fatty acid binding protein) of acute myocardial injury. The 11 remaining cardiac patients were diagnosed with acute cholecystitis during their hospitalization or at the time of admission. Prolonged fasting and/or staying in an intensive care unit (ICU) may have contributed to their condition. Among these 11 patients, aortic dissection was the most prevalent underlying cardiac condition, affecting 5 patients.ConclusionsAlthough it is a rare condition, acute cholecystitis may coexist with or be misdiagnosed as a cardiovascular disorder. This possibility should not be overlooked in cardiac patients because a delay in treatment may result in critical complications.

show abstract

Acute coronary syndrome mimicked by acute cholecystitis

Cited by 13 publications

References 9 publications

Electrocardiographic Changes and False-Positive Troponin I in a Patient with Acute Cholecystitis

Electrocardiographic Changes and False-Positive Troponin I in a Patient with Acute Cholecystitis

Gastric dilatation and intestinal obstruction mimicking acute coronary syndrome with dynamic electrocardiographic changes

Acute cholecystitis mimicking or accompanying cardiovascular disease among Japanese patients hospitalized in a Cardiology Department

Contact Info

Product

Resources

About