Complete atrioventricular block in a patient with acute cholecystitis: a case of cardio-biliary reflex?

Franzen, Daniel; S, Jung; Fatio, Renata; Brunckhorst, Corinna

doi:10.1097/mej.0b013e32832baed8

Cited by 26 publications

(12 citation statements)

References 4 publications

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“…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

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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.

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Section: Discussionmentioning

confidence: 99%

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

Demarchi

Regusci²,

Fasolini³

2012

Case Rep Gastroenterol

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“…(3) There is direct damage of myocytes secondary to proteolytic enzymes, such as trypsin. This can modify the permeability of the membrane, cause direct membrane injury, and induce necrosis generating an electrical disturbance and ECG abnormalities [ 11 – 13 ]. (4) Vasovagal stimulus secondary to the acute intra-abdominal disease can cause a cardiobiliary reflex.…”

Section: Discussionmentioning

confidence: 99%

“…(4) Vasovagal stimulus secondary to the acute intra-abdominal disease can cause a cardiobiliary reflex. This vagal stimulation can cause cardiac electrical and mechanical disturbances presenting as bradycardia, AV block, hypotension, and syncope [ 13 , 14 ]. (5) Other conditions, including coagulopathy, exacerbation of underlying cardiac disease, and coronary vasospasm [ 5 ], as well as stress-induced cardiomyopathy, can also be present in acute cases of pancreatitis [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Pancreatitis Mimicking ST-Segment Elevation Myocardial Infarction

Agrawal

Sayyida

Peñalver

et al. 2018

Case Reports in Cardiology

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Introduction Electrocardiographic changes imitating myocardial ischemia have been occasionally reported in patients with intra-abdominal pathology including acute pancreatitis. Case Report A 60-year-old man with no past medical history presented to the emergency department (ED) after a syncopal episode. In ED, his vitals were stable. His ECG showed sinus bradycardia at 53 beats per minute, peaked T waves, 1 mm ST-segment elevation in leads II, III, and aVF, and 2 mm ST elevation in V3 as shown in the figures. With the concern for STEMI, he was taken for left heart catheterization (LHC) emergently, showing nonobstructive coronary artery disease (CAD). His laboratory workup was remarkable for lipase of 25,304 IU/l (normal level 8–78 IU/l). His liver function test and triglyceride level were normal. Troponin was <0.01 ng/ml. A computed tomographic exam of the abdomen revealed acute interstitial pancreatitis with a small discrete fluid collection in the uncinate process. He was treated with aggressive intravenous fluid resuscitation and was discharged on day 3. Discussion Intra-abdominal pathologies like acute pancreatitis can lead to transient ECG changes mimicking STEMI. It is important to use ECG clues, echocardiographic findings, and clinical judgement to avoid cardiac catheterization, contrast exposure, and associated health care costs.

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“…Interrelated to pancreatitis, there have been several reported cases of ischemic mimicry occurring in cholecystitis patients [10, 49, 50, 51]. Morrison and Swalm [52] proposed a cardio-biliary reflex that results in a vagal nerve-mediated attenuation of inotropy stemming from pain stimulus in the gall bladder.…”

Section: Pathogenesis Of Electrocardiogram Changesmentioning

confidence: 99%

Acute Pancreatitis Masquerading as Inferior Wall Myocardial Infarction: A Review

Lange

Broor

et al. 2019

Case Rep Gastroenterol

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A rare presentation of acute pancreatitis is with electrocardiographic (ECG) changes that mimic myocardial ischemia. We present a report of a patient that presented with hemodynamic instability and new ECG changes of ST segment elevations in contiguous leads II, III, and aVF mimicking an inferior wall myocardial infarction. Emergent coronary angiography showed no significant coronary obstruction, but it was followed by a left-sided hemiplegia with radiographic evidence of diffuse embolic stroke. The patient was later found to have an underlying diagnosis of pancreatitis. Additional history that later became available indicated a history of severe acute pancreatitis treated elsewhere a few months prior to the current admission. We present the first comprehensive review of the literature comprising 36 total cases with pancreatitis masquerading as acute myocardial infarction, with inferior wall STEMI pattern being the most frequent. We present this case to highlight the diagnostic dilemma posed by this masquerade of a high acuity myocardial infarction and to highlight alternative diagnoses to be considered in such clinical circumstances.

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Complete atrioventricular block in a patient with acute cholecystitis: a case of cardio-biliary reflex?

Cited by 26 publications

References 4 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

Acute Pancreatitis Mimicking ST-Segment Elevation Myocardial Infarction

Acute Pancreatitis Masquerading as Inferior Wall Myocardial Infarction: A Review

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