Effect of Distention of the Biliary Tract on the Electrocardiogram

New‐Onset QT Prolongation and Torsades De Pointes Accompanied by Left Ventricular Dysfunction Secondary to Acute Pancreatitis

“…To further explain the etiology of ECG ST‐segment and T wave changes seen in biliary tract disease, the presence of a cardiobiliary reflex has been proposed 6,7 . Hodge and Messer documented ECG changes in 26 patients with known coronary artery disease undergoing biliary tract surgery in whom the gallbladder and common bile duct were distended 7 .…”

Acute Cholecystits Leading to Ischemic ECG Changes in a Patient with No Underlying Cardiac Disease

“…21,22 Decreased coronary blood flow was demonstrated in dogs during distension of the common bile duct, 23 and in pigs, which showed a graded response to the magnitude of distension. 24 The reflexive coronary vasoconstriction was unaffected by atropine and propranolol, but was abolished with phentolamine, 20 indicating the reflex has an α-adrenergic sympathetic arc.…”

Pancreatitis with Electrocardiographic Changes Mimicking Acute Myocardial Infarction

“…Furthermore, no pleuritic chest pain, pericardial friction rub or pericardial effusion was present in our patient. Several investigators have postulated the existence of a cardiobiliary reflex (22,23,(45)(46)(47), which may cause cardiac damage by direct action on the myocardium or by altering coronary blood flow (48,49). Although innervation to the heart and gallbladder arises from different spinal levels, Morrison and Swulim (49) evoked the possibility of a vagally mediated reflex, later shown to travel through intermediate neurons connecting these rami.…”

“…Some studies, however, have reported vagally mediated ECG changes only in subjects with underlying coronary artery disease. Hodge et al (45) noted ECG changes with gallbladder distention in dogs only when experimentally induced coronary lesions were produced. A later study of 26 patients undergoing biliary tract surgery in whom the gallbladder and common bile duct were distended confirmed ECG changes only in the presence of underlying coronary artery disease (47).…”