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Year : 2020  |  Volume : 9  |  Issue : 4  |  Page : 176-178

Cope’s sign and complete heart block secondary to acute cholecystitis: A case report

1 Department of Trauma and Emergency, AIIMS, Patna, Bihar, India
2 Department of Emergency Medicine, Paras Global Hospital, Darbhanga, Bihar, India
3 Department of Anaesthesiology & Critical Care, IGIMS, Patna, Bihar, India
4 Department of Anesthesiology, AIIMS, Patna, Bihar, India

Correspondence Address:
Neeraj Kumar
Department of Trauma and Emergency, AIIMS, Patna, Bihar
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2221-6189.288597

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Rationale: Cope’s sign is reflex bradycardia seen in the patient presenting with symptoms of acute cholecystitis. This bradycardia may be due to vagally mediated cardio-biliary reflex. Many of these reflexes due to acute cholecystitis have similar clinical features (some electrocardiographic changes like bradycardia, complete heart block, and asystole) mimicking that of acute coronary syndrome. Patient’s concern: A 60-year old male presented with symptoms of acute cholecystitis and referred to the emergency department with complete heart block and abdominal pain with hypotension requiring an emergency temporary pacemaker. Diagnosis: Cope’s sign and complete heart block. Intervention: Emergency temporary cardiac pacemaker insertion. Outcomes: The patient was discharged after three days with regular follow-up and advice for laparoscopic cholecystectomy. Lessons: Complete heart block or any symptomatic bradycardia associated with abdominal pain should be under consideration of cholecystitis that may be associated with either presence or absence of gall stones due to cardio biliary reflex.

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