engleski

Acute cholecystitis associated with electrocardiographic changes of the ST-T segment and an increase in cardiac biomarkers.

Introduction: Acute cholecystitis is often associated with transient electrocardiographic ST-T segment changes and cardiac biomarker elevation with or without myocardial ischemia. Elevation in troponin in acute cholecystitis are well described, however, few data exist on high sensitivity troponin (hsT).1 We present a case of a 77-year-old female with simultaneous development of acute cholecystitis and ECG and laboratory changes characteristic for myocardial infarction. Case report: 77-year-old female presented with right upper abdominal quadrant pain, nausea and vomiting, denying chest pain. Vital signs were normal. Physical examination revealed right upper quadrant and epigastric tenderness. 12- lead ECG showed atrial fibrillation with ST segment depression and T-waves inversion in the most leads. Laboratory investigations showed normal WCC count, CRP, aminotransferase and amylase levels, bilirubin was 28.8 μmol/L, hsT 66 ng/L, CK 216 U/L. Abdominal ultrasound revealed normal gallbladder wall and two stones in the lumen. Echocardiography revealed mildly reduced systolic function (LVEF 48%) with no regional contractility abnormalities. Repeated laboratory findings showed elevation in hsT to 1076 ng/L and CK to 489 U/L. Patient was admitted to Cardiology Intensive Care Unit with working diagnosis of acute coronary syndrome. Next day patient became febrile (39.0 C), with severe tenderness of upper abdomen, positive Murphy's sign, findings showed elevation in WCC 13.1×109/L and CRP 214 mg/L. Repeated ultrasound showed gallbladder distention, wall thickening, impaction of one of the stones in cystic duct, so indication for surgical treatment was established. Classified as a ASA IV/V class the patient was transferred to Abdominal Surgery Department. After surgery, patient developed sepsis and two days following surgery a cardiorespiratory arrest resistant to cardiopulmonary resuscitation. According to patients family request, autopsy has not been performed. Conclusion: Nonspecific electrocardiographic ST-T segment changes and cardiac biomarker elevation characteristic for severe acute cholecystitis could mask acute abdominal pathology, especially in early stages of the disease, which could lead to delay in establishing the diagnosis. Nevertheless, if signs of myocardial ischemia are present the prognosis is worse.

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