P4447 - When Gallstones Imitate a Heart Attack: A Rare Cardiac Manifestation of Pancreatitis

Ibrahim Shanti, MD¹, Alhasan Alzubi, MD², Mohammad Shelig, MD², Mamdouh Souleymane, MD², Wesam Frandah, MD³, Ahmed Sherif, MD³
1Marshall University - - Huntington, WV, Huntington, WV; 2Joan C. Edwards School of Medicine, Marshall University, Huntington, WV; 3Marshall University Joan C. Edwards School of Medicine, Huntington, WV

Introduction: Electrocardiographic (ECG) abnormalities are recognized in acute pancreatitis, often in severe disease. However, transient conduction disturbances in mild pancreatitis without systemic compromise are rarely reported.

Case Description/

Methods: A 43-year-old male presented with epigastric and right upper quadrant pain, nausea, and vomiting. Laboratory studies revealed a lipase level of 2,456 U/L, confirming acute pancreatitis. Imaging showed gallstones and biliary sludge without ductal dilation. He was hemodynamically stable with normal electrolytes. Initial ECG showed T wave abnormalities; repeat ECG revealed a new conduction disturbance. Despite the absence of chest pain or cardiac risk factors, echocardiography showed anterior wall hypokinesis, prompting coronary angiography, which demonstrated normal coronary arteries and preserved systolic function. The conduction abnormality resolved spontaneously as the pancreatitis improved.

Discussion: This case highlights a rare, transient cardiac conduction abnormality during mild pancreatitis in the absence of ischemia or systemic inflammation. The findings underscore the need for careful cardiac evaluation to differentiate pancreatitis-related ECG changes from primary cardiac pathology, especially in hemodynamically stable patients.


Figure: Figure 1. EKG Demonstrating New-Onset Left Bundle Branch Block (LBBB) with Persistent T Wave Inversions in Leads V1–V5 and No ST Segment Changes


Figure: Figure 2. Left Heart Catheterization (LHC) Revealing Normal Coronary Arteries

Disclosures:
Ibrahim Shanti indicated no relevant financial relationships.
Alhasan Alzubi indicated no relevant financial relationships.
Mohammad Shelig indicated no relevant financial relationships.
Mamdouh Souleymane indicated no relevant financial relationships.
Wesam Frandah: Boston Scientific – Advisor or Review Panel Member, Consultant. Merritt – Consultant. Olympus corporation of America – Consultant.
Ahmed Sherif indicated no relevant financial relationships.

Ibrahim Shanti, MD¹, Alhasan Alzubi, MD², Mohammad Shelig, MD², Mamdouh Souleymane, MD², Wesam Frandah, MD³, Ahmed Sherif, MD³. P4447 - When Gallstones Imitate a Heart Attack: A Rare Cardiac Manifestation of Pancreatitis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.