Dynamic ECG Changes Mimicking ST Elevation Myocardial Infarction in a Patient with Acute Calculous Cholecystitis: A Case Report

Introduction: It is well known that acute cholecystitis can sometimes mimick coronary ischemia with similar pattern of chest pain and ST segment changes and T-wave inversions in ECG. However, dynamic ECG changes which are highly suggestive of coronary ischemia, in a patient of acute calculous cholecystitis is a rare phenomenon. A normal coronary angiogram established that the peculiar ECG changes in this particular patient was attributable to the acute abdominal pathology. Case presentation: A 45 year old Indian lady with chief complaints of chest and upper abdominal pain associated with giddiness of four days duration was diagnosed to have acute calculous cholecystitis on abdominal ultrasound. Her serial ECG’s showed dynamic changes (initial bradycardia, PR prolongation followed by ST segment elevation in inferior leads) which was indicative of cardiac ischemia. This prompted us to subject the patient to a coronary angiogram which was normal. Repeat abdominal ultrasound and MRI supported the diagnosis of acute calculous cholecystitis . Our patient subsequently underwent successful laparoscopic cholecystectomy which led to complete resolution of her ECG changes. Although it is well known that ST segment changes in ECG may be associated with surgical conditions like acute cholecystitis, but such dynamic ECG changes which is usually indicative of cardiac ischemia, as was evident in our patient, is a rare phenomenon. Conclusion: Physicians should be aware of transient or dynamic ECG changes in patients with acute cholecystitis. The symptoms of cholecystitis and acute coronary syndrome may be similar; therefore in abdominal pain patients especially with dynamic ECG changes as in this index case, acute coronary syndrome should be excluded.