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Acute Calculous Cholecystitis With Sinus Bradycardia: Cope's Sign Encountered

Haris Iftikhar1, Feroze Salahuddin Khan2, Nood Dhafi R Al-Marri1

  • 1Emergency Medicine, Hamad Medical Corporation, Doha, QAT.

Cureus
|February 15, 2022
PubMed

Insights

Acute cholecystitis can mimic cardiac ischemia, causing ECG changes and arrhythmias. Promptly managing gallbladder disease can resolve these cardiac symptoms, highlighting a potential cardio-biliary reflex.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Emergency Medicine

Background:

  • Acute cholecystitis and cardiac ischemia share overlapping clinical presentations.
  • Nonspecific electrocardiographic (ECG) changes and arrhythmias in gallbladder disease can mislead physicians, prompting extensive cardiac evaluations.

Observation:

  • A 53-year-old male presented with abdominal pain, nausea, and vomiting, along with sinus bradycardia on ECG.
  • Diagnostic imaging confirmed acute calculous cholecystitis.
  • Cardiac workup yielded unremarkable findings.

Findings:

  • Sinus bradycardia resolved following the management of acute cholecystitis.
  • This suggests a "cardio-biliary reflex" triggered by gallbladder inflammation and pain.
  • Autonomic vagal innervation plays a role in this reflex pathway.

Implications:

  • Emergency physicians and cardiologists must recognize ECG changes associated with acute cholecystitis.
  • Awareness can expedite appropriate treatment for gallbladder disease, preventing unnecessary cardiac interventions.
  • Timely management of cholecystitis can lead to the resolution of cardiac manifestations.

Keywords:
biliary colicbradycardiacardio-biliary reflexcholecystitischolelithiasisgall bladder

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