Acute cholecystits leading to ischemic ECG changes in a patient with no underlying cardiac disease

Area of Science:

• Cardiology
• Gastroenterology
• Surgical Conditions

Background:

• Chest pain with ST-segment elevation typically suggests cardiac ischemia.
• However, ST-segment elevation has been documented in non-cardiac surgical conditions, including acute cholecystitis.
• This presentation underscores the diagnostic challenges in differentiating cardiac and non-cardiac causes of ST-segment elevation.

Purpose of the Study:

• To report a case of acute cholecystitis presenting with ST-segment elevation mimicking myocardial infarction.
• To review existing literature on cholecystitis-induced electrocardiogram (ECG) changes.
• To propose a pathophysiological mechanism for these ECG abnormalities.

Main Methods:

• Case report of a 34-year-old female with symptoms of acute cholecystitis.
• Electrocardiogram (ECG) analysis revealing inferolateral ST-segment elevation.
• Diagnostic workup including ultrasound and laparoscopic cholecystectomy; literature review.

Main Results:

• The patient presented with symptoms consistent with acute cholecystitis but showed ECG changes indicative of myocardial infarction.
• Further investigations excluded an acute cardiac event; ultrasound confirmed gallstones, and laparoscopic cholecystectomy revealed an inflamed gallbladder.
• Resolution of symptoms and normalization of ECG occurred post-cholecystectomy. This case represents the youngest patient reported with this condition.

Conclusions:

• Acute cholecystitis can induce significant ECG changes, including ST-segment elevation, mimicking acute myocardial infarction.
• The pathophysiological mechanism linking gallbladder inflammation to ECG changes warrants further investigation.
• Clinicians should consider acute cholecystitis as a differential diagnosis for chest pain with ST-segment elevation, especially when cardiac investigations are inconclusive.