Electrocardiographic changes in cardiac patients with acute gallbladder disease

Acute cholecystitis or biliary colic may be associated with angina pectoris, arrhythmias, or nonspecific ST-T wave changes on the electrocardiogram. A vagally mediated cardio-biliary reflex is the presumed cause of these changes. Three cases of acute exacerbation of biliary tract disease in patients with known coronary artery disease associated with transient electrocardiographic changes and no concurrent cardiac complaints or abnormalities are reported. The signs and symptoms of gallbladder and heart disease may overlap, making diagnosis difficult. These patients underwent extensive workups of both their cardiac and biliary disease, which did not document any acute cardiac problem. In patients with known coronary artery disease and acute cholecystitis, the surgeon should not be discouraged from cholecystectomy merely because of a "questionable" electrocardiogram. Undue delay in treatment while awaiting the results of the cardiac screen may result in both cardiac and septic complications.