Can gallstones cause shortness of breath. What are the common symptoms of gallbladder problems. How can you distinguish between gallbladder issues and other abdominal emergencies. When should you seek immediate medical attention for abdominal pain.

The Connection Between Gallbladder Problems and Respiratory Issues

Many people wonder if gallbladder problems, particularly gallstones, can cause shortness of breath. While it’s not a typical symptom, there are situations where gallbladder issues might indirectly affect breathing. Understanding this connection requires a closer look at gallbladder function and the symptoms associated with gallstones.

Can Gallstones Directly Cause Shortness of Breath?

Gallstones themselves do not directly cause shortness of breath. However, in severe cases of gallbladder inflammation or infection, the pain and discomfort may be so intense that it affects normal breathing patterns. This is particularly true if the inflammation spreads to nearby organs or tissues.

Indirect Effects on Breathing

In some cases, gallbladder problems might indirectly affect breathing through:

• Pain-induced shallow breathing
• Referred pain to the chest area
• Anxiety or stress related to gallbladder discomfort

Recognizing Common Gallbladder Symptoms

To better understand gallbladder issues, it’s crucial to recognize the typical symptoms associated with gallstones and other gallbladder problems.

Primary Symptoms of Gallstones

The most common symptoms of gallstones include:

1. Sudden, intense pain in the upper right abdomen
2. Pain that radiates to the back or right shoulder
3. Nausea and vomiting
4. Fever and chills (in case of infection)
5. Jaundice (yellowing of skin and eyes)

Atypical Symptoms

Sometimes, gallbladder problems may present with less common symptoms, such as:

• Indigestion or bloating
• Intolerance to fatty foods
• Unexplained weight loss

Distinguishing Gallbladder Issues from Other Abdominal Emergencies

Gallbladder problems are just one of several potential abdominal emergencies. It’s crucial to be able to distinguish between them to ensure proper treatment.

Key Differences in Symptoms

Here’s how gallbladder issues may differ from other abdominal emergencies:

• Appendicitis: Pain typically starts around the navel and moves to the lower right abdomen
• Pancreatitis: Pain is often in the upper left or middle abdomen and may radiate to the back
• Kidney stones: Pain usually starts in the side and back, below the ribs, and may radiate to the lower abdomen and groin

When to Seek Immediate Medical Attention

Understanding when abdominal pain warrants a trip to the emergency room is crucial for managing potential gallbladder issues and other abdominal emergencies.

Red Flags for Immediate Care

Seek immediate medical attention if you experience:

1. Severe, persistent abdominal pain
2. Fever above 101°F (38.3°C)
3. Yellowing of the skin or eyes
4. Persistent nausea and vomiting
5. Dark urine or clay-colored stools

Diagnosis and Treatment of Gallbladder Problems

Proper diagnosis and treatment of gallbladder issues are essential for managing symptoms and preventing complications.

Diagnostic Procedures

Doctors may use various methods to diagnose gallbladder problems:

• Ultrasound
• CT scan
• HIDA scan
• Blood tests

Treatment Options

Treatment for gallbladder issues may include:

1. Watchful waiting for small, asymptomatic gallstones
2. Medications to dissolve gallstones
3. Surgical removal of the gallbladder (cholecystectomy)
4. Dietary changes to manage symptoms

Prevention and Lifestyle Changes for Gallbladder Health

While not all gallbladder problems can be prevented, certain lifestyle changes may reduce the risk of developing gallstones and other issues.

Dietary Modifications

Consider the following dietary changes to promote gallbladder health:

• Maintain a healthy weight
• Eat a balanced diet rich in fruits, vegetables, and whole grains
• Limit high-fat and processed foods
• Stay hydrated

Exercise and Stress Management

Regular physical activity and stress reduction techniques can also contribute to overall gallbladder health:

1. Engage in moderate exercise for at least 30 minutes most days of the week
2. Practice stress-reduction techniques such as meditation or yoga
3. Get adequate sleep
4. Avoid rapid weight loss, which can increase the risk of gallstones

Understanding the Role of the Gallbladder in Digestion

To fully grasp the impact of gallbladder problems, it’s essential to understand the organ’s role in the digestive process.

Function of the Gallbladder

The gallbladder plays a crucial role in digestion by:

• Storing bile produced by the liver
• Concentrating bile to make it more effective
• Releasing bile into the small intestine to help break down fats

Consequences of Gallbladder Removal

After gallbladder removal, most people can lead normal lives with some dietary adjustments:

1. The liver continues to produce bile, but it flows directly into the intestine
2. Some people may experience looser stools or more frequent bowel movements
3. Gradual reintroduction of fatty foods is often recommended

Understanding the complexities of gallbladder health and its potential impact on overall well-being is crucial for maintaining digestive health. While gallstones may not directly cause shortness of breath, they can lead to significant discomfort and potentially serious complications if left untreated. By recognizing the symptoms of gallbladder problems and other abdominal emergencies, individuals can seek timely medical attention and receive appropriate care. Additionally, adopting a healthy lifestyle that includes a balanced diet, regular exercise, and stress management can contribute to gallbladder health and overall digestive wellness.

As medical understanding continues to evolve, it’s important to stay informed about the latest research and recommendations regarding gallbladder health. Regular check-ups with a healthcare provider can help identify potential issues early on and ensure proper management of any existing conditions. By taking a proactive approach to gallbladder health, individuals can minimize the risk of complications and maintain optimal digestive function.

In conclusion, while the connection between gallbladder issues and shortness of breath may not be direct, the overall impact of gallbladder problems on one’s health and quality of life can be significant. By staying informed, recognizing symptoms, and seeking timely medical care, individuals can effectively manage gallbladder issues and maintain their overall health and well-being.

Can gallstones cause shortness of breath?

Dr Jason Wong

Bariatric (Obesity) Surgeon, General Surgeon, Laparoscopic Surgeon, Upper GI Surgeon (Abdominal)

Jason Wong is a skilled Laparoscopic and Bariatric Surgeon with expertise in sleeve and gastric bypass surgery, gallbladder, hernia, endoscopic pilonidal, antireflux and emergency general …
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Whilst gallstones are a common cause of upper abdominal pain – it is not the only cause of upper abdominal pain or right upper abdominal pain. Furthermore, just because you have gallstones does not necessarily mean that they are the cause of your symptoms.  One should never assume things as this is the worst mistake in medicine.

The description of your symptoms do not sound like any one thing in particular and sound more like a collection of symptoms:

1. “Cannot digest properly and burping after meals” – many reasons that this sensation may occur and would need to clarify what is meant by not digesting properly. Eating too fast, aerophagia, anxiety, stress are some non-pathological reasons for these symptoms. They are not typical symptoms of gallstones.

2. Tense muscles are not a typical symptom of gallstones – certainly sounds more musculoskeletal.

3. Unable to breathe properly – not a typical symptom of gallstones and only a problem related to gallstones when have cholecystitis and peritonism.

I would recommend visiting your usual GP to get some investigations performed and if stress is a particular issue at the moment which certainly can lead to some of the symptoms you are experiencing, counselling and stress management techniques may be helpful.

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Watch Out for Gallstones and Five Other Abdominal Emergencies

Gallstones are a common condition that can get worse if not managed. Having gallstones in your gallbladder can cause a considerable amount of pain in your abdomen and lower back areas. When are abdominal pains bad enough to require a visit to the ER? Let’s start with gallstones and then add five other abdominal emergencies that warrant a trip to the emergency room.

What are Gallstones?

Gallstones are hard deposits that form in your gallbladder. They can form when there’s too much cholesterol or waste in your bile, or if your gallbladder doesn’t empty properly. Medication may aid in dissolving gallstones, but in more urgent scenarios, surgery may be needed.

What are the symptoms?

A gallbladder attack causes a sudden gnawing pain that gets worse. You may feel it in the upper right or center of your belly, your lower back, or between your shoulder blades. You might also vomit or feel nauseous. Other tell-tale signs include:

• Jaundice
• Tenderness when urinating
• A sharp pain in the abdomen
• Difficulty relieving yourself on the toilet

What Are the Treatments for Gallstones?

Surgical removal of the gallbladder is a frequent remedy. Gallstones are a common reason to go to the ER, because a person with this condition may require immediate removal of the gallbladder.

Other Abdominal Emergencies

Abdominal Aortic Aneurysm

An abdominal aortic aneurysm is when part of your aorta balloons with blood and ends up running through your abdomen. Over time, the bulge in your aorta weakens until the force of normal blood pressure can cause it to rupture. This can lead to severe pain and massive internal bleeding. Symptoms include:

• Persistent abdominal pain
• Back pain
• Low blood pressure

An abdominal aortic aneurysm is most often seen in males over age 60 who have one or more risk factors. The larger the aneurysm, the more likely it is to break open or tear. This can be life threatening and requires emergency care.

Ectopic pregnancy

An ectopic pregnancy occurs when a fertilized egg grows outside of the uterus. Almost all ectopic pregnancies—more than 90%—occur in a fallopian tube. As the pregnancy grows, it can cause the tube to rupture. A rupture can cause internal bleeding which can be a life-threatening emergency that needs immediate surgery.

Symptoms include:

• Missed menstrual period
• Tender breasts
• Upset stomach
• Abnormal vaginal bleeding
• Lower back pain
• Pain in the abdomen or pelvis
• Mild cramping on one side of the pelvis

Abnormal bleeding and pelvic pain should be brought to the attention of your obstetrician–gynecologist immediately. If you have sudden, severe pain; shoulder pain; or weakness, you should go to an emergency room.

Gastritis

Gastritis causes the inflammation of your stomach lining. The bacteria that causes Gastritis may also be found in patients suffering from ulcers. Other symptoms include:

• Nausea
• Dizziness
• Pain in the abdomen
• Diarrhea

Gastritis is an emergency if you have severe abdominal pain and vomiting. Symptoms include:

• Paleness
• A racing heartbeat
• Dizziness and shortness of breath
• Chest pain
• Severe stomach pain
• Vomiting blood
• Bloody stool

Peptic ulcer

A peptic ulcer is an open sore or raw area found in the lining of your stomach or intestine. It causes the breakdown of your stomach lining. Symptoms of an ulcer include:

• Nausea
• Dizziness
• Headaches
• Diarrhea
• Abdominal pain

An ulcer becomes an emergency when perforation takes place. A perforated ulcer is a condition in which an untreated ulcer has burned through the gastrointestinal tract, allowing gastric fluid to leak into the abdominal cavity. Symptoms of a perforated ulcer include:

• Sudden, severe pain in the upper abdomen
• Pain spreading to the back or shoulder
• Upset stomach
• Nausea
• Vomiting
• Lack of appetite
• Bloating

Excessive Vomiting

Vomiting is your body’s way of letting you know that you’ve ingested something that doesn’t settle right in the stomach. If you suffer from recurrent vomiting, this may be caused by underlying medical conditions that need medical assessment. In some cases, vomiting can lead you to require emergency medical attention. You should immediately go to the doctor if you:

• Vomit for more than one day
• Suspect food poisoning
• Have a severe headache accompanied by a stiff neck
• Experience abdominal pain

It’s difficult to entirely avoid viruses that cause vomiting. However, you can reduce your chances of getting a virus by exercising good hygiene, like washing your hands regularly.

Don’t delay in an emergency. Your safe care is our #1 priority.

Sources:
Medical News Today
Science Daily
Medline Plus
Healthline
American College of Obstetricians and Gynecologists

Cholecystitis: signs, how to treat | MRI Expert

Modern medicine has to face the pathology of the biliary tract quite often. And the number of such diseases continues to grow. Today we will talk about cholecystitis: what kind of disease it is, what are its symptoms, causes, how it is detected and treated.

Nikolai Borisovich Patrushev, a gastroenterologist at the Expert Clinic Perm, answers our questions.

Modern medicine has to deal with the pathology of the biliary tract quite often. And the number of such diseases continues to grow. Today we will talk about cholecystitis: what kind of disease it is, what are its symptoms, causes, how it is detected and treated.

Nikolai Borisovich Patrushev, a gastroenterologist at the Expert Clinic, Perm, answers our questions.

— Nikolai Borisovich, there is evidence that today 10-20% of the adult population suffers from cholecystitis, and there is a tendency to a further increase in this pathology. Can you please tell me what it is?

— In one sentence, cholecystitis is an inflammation of the gallbladder. Pathology of the biliary tract remains an urgent problem for today’s medicine. Yes, there is an upward trend in the incidence. Moreover: according to scientists, the number of diseases of the digestive system (which includes the pathology of the biliary tract) in the next 15-20 years will increase in the world by 30-50%.

— What types of cholecystitis are known to modern medicine?

— There are two of them: acute and chronic cholecystitis. The first develops quickly, against the background of complete well-being. There is pain in the abdomen, the pain is localized in the right hypochondrium. Nausea, vomiting, and fever may occur. As a rule, acute cholecystitis is most often a manifestation of cholelithiasis. Such patients are hospitalized by ambulance in a surgical hospital.

Read more about gallstone disease here: Remove or keep? What to do if gallstones are found?

Chronic cholecystitis initially develops as an independent process, gradually, imperceptibly. Often, the diagnosis of “cholecystitis” is made to the patient during examination for completely different diseases.
It should also be taken into account that diseases of the gallbladder and biliary tract are characterized by a variety of clinical manifestations, duration of the course, protracted exacerbations – this leads to frequent seeking medical help, makes these ailments a social problem.

— What are the causes of cholecystitis? What causes it?

— Various factors are involved in the development of this pathology. In the first place, I would put a violation of the contractile function of the gallbladder. This leads to stagnation of bile, slowing down its evacuation from the gallbladder. Most often, the contractile function of the gallbladder is affected by psycho-emotional overload, neurotic reactions and prolonged stressful situations, physical inactivity.

The infectious factor is also important. Infectious agents penetrate the gallbladder from chronic foci of inflammation in the body – for example, in diseases of the upper respiratory tract, stomach, duodenum, and other parts of the intestinal tube.

Contribute to the development of cholecystitis and helminthic invasions – say, opisthorchiasis. Hepatitis A (Botkin’s disease) can also lead to inflammation of the gallbladder.

This disease can also be provoked by the reflux of pancreatic juice into the gallbladder cavity – the so-called chemical burn of the gallbladder mucosa occurs, which can lead to its inflammation.

Read related materials:

How to protect yourself from Botkin’s disease?
Is there a stress vaccine?
Childhood – for movement! What does hypodynamia lead to?

— Please tell us about the signs of cholecystitis. How does it manifest itself?

— Cholecystitis can occur with varying degrees of severity. From this, as well as from the stage of the disease, the symptoms will depend. First of all, the pathology is manifested by pain syndrome. These pains occur due to spasm of the gallbladder or due to its stretching.

Pain appears in the right hypochondrium, as a rule, 40 minutes – 1.5 hours after an error in the diet (for example, when eating spicy, fatty foods, fried foods, overeating). The pain is felt for about half an hour and with a mild form passes on its own. In severe forms, the pain is more intense and prolonged.

Pain can also be provoked by a long stay of a person in a sitting position – driving a car, at a computer. From the right hypochondrium, such pains can give up – to the right shoulder, neck, right shoulder blade.

In addition to pain, the patient may be disturbed by the so-called dyspeptic disorders: belching, nausea, metallic taste in the mouth, sometimes vomiting (if it occurs repeatedly, bile may appear in it). There may be bloating, alternating constipation and diarrhea.

Also, cholecystitis can be accompanied by irritability, insomnia, decreased performance.

The more severe the form of cholecystitis, the brighter and longer the listed symptoms will be expressed.

— Does asymptomatic cholecystitis happen? That is, a person is not bothered by anything, and the disease is detected only when conducting any diagnostic tests – for example, as part of a preventive examination

— Yes, this happens. In 50% of cases, cholecystitis is latent, asymptomatic. Only ultrasound data can indicate signs of gallbladder pathology before clinical manifestations of the disease. Therefore, this study must be included in the program for examining diseases of the digestive system.

In addition, there are atypical clinical forms that can mislead the doctor, simulating various diseases of other organs and systems, for example, cardiovascular, endocrine and others (the so-called “masks”). And when we begin to understand, it turns out that we are talking about the pathology of the gallbladder. The most famous and studied is the so-called cardiac mask of cholecystitis (or cholecystocardiac syndrome): every third or second patient with cholecystitis may complain of heart problems. This is a rapid heartbeat, shortness of breath, pain in the heart. Electrocardiogram in such patients without any abnormalities.

Cholecystitis can also occur under the guise of a pathology of the thyroid gland – here the patient’s complaints will be like with thyrotoxicosis (irritability, excessive sweating, the same rapid heartbeat, trembling of the fingers, an increase in body temperature to values ​​of 37-37.5 degrees). In this case, the thyroid gland may turn out to be somewhat enlarged, and here it is necessary to understand whether the symptoms are caused by its pathology, or the problem is still in the gallbladder.

Cholecystitis may also have an allergic mask, and a number of others. To understand this, the doctor must have considerable practical experience, correctly build a diagnostic search.

– Let’s talk about diagnosing cholecystitis. What does it include? How can a doctor detect this pathology?

— Today, the most accessible and common method for diagnosing cholecystitis is abdominal ultrasound. Ultrasound diagnostics allows you to assess the condition of the walls of the gallbladder: if they are thickened by more than 4 mm, this is already a clear sign of cholecystitis, if less, perhaps the pathology is only at the beginning of development. The doctor also evaluates the contractility of the gallbladder.

Ultrasound can also detect gallstones. If they are found and there is also cholecystitis, then they speak of stone (calculous) cholecystitis.

You can sign up for ultrasound of the abdominal organs here
ATTENTION: the service is not available in all cities

There are other methods of examination. For example, sounding of the duodenum (duodenal sounding). It allows you to evaluate the biochemical composition of bile, sow it for the presence of infection and identify microbes that cause inflammation in the gallbladder.

— How can doctors help a patient with this disease? How is cholecystitis treated?

— We can help only after, during a full examination, we find out as fully as possible all the reasons that led to the appearance of cholecystitis in the patient. The treatment program is built as follows. The first is medical nutrition. First of all, it is a fractional meal, five to six times a day. The gallbladder “likes” that we take food at the same hours: this is how we train it and prevent stagnation of bile in it. It is important that the food is not hot or cold, but warm.

Selection of drugs is carried out taking into account the function of the gallbladder, in particular, its contractility. If the function is increased, if there are sharp spastic pains, antispasmodic drugs are recommended. When, with the normal contractile function of the organ, we find signs of viscous, stagnant bile, agents with a choleretic effect are used.

If studies show poor contractility of the bladder, then the treatment program includes drugs that stimulate its function, help it work properly.

In certain cases, antiparasitic, antibacterial, anti-inflammatory agents are used. All this is decided by the doctor, depending on the results of the study.

Let’s not forget about other methods of treatment of cholecystitis – the same spa treatment. Chronically ill people need to go to resorts for at least three or four years in a row – as they used to say, “to the waters”. It is very useful. But you need to go there with all the medical documents, then the patient will choose the right diet, water intake regimen (its type, amount and temperature regime) there.

— What can and cannot be eaten with cholecystitis?

– Proteins, fats and carbohydrates should be exactly as much as is necessary for the normal functioning of the body. The diet should include lean meats (beef, rabbit meat), fish (preferably boiled or steamed), fat-free cottage cheese, wheat bran. Among cereals, preference is given to oatmeal and buckwheat.

Let’s not forget about fresh vegetables and fruits (it’s better to have melon, pumpkin, watermelon, carrots, apples).

Fatty, fried foods, smoked meats, marinades, pickles, alcoholic beverages, including beer, are excluded. The same list includes carbonated drinks, hot spices and egg yolks (the latter – for the period of exacerbation).

Fasting days (1-3 per week) will not interfere: these can be rice-compote, cottage cheese, watermelon days. In addition, drinking plenty of water is recommended.

— How to prevent the development of cholecystitis? Please tell us about prevention

— Probably, a lot of things are already clear from the above. Basic prevention differs little from the prevention of many other diseases. This is a healthy lifestyle, rational nutrition – we eat often, not on the run, we chew food thoroughly, slowly.

Agree, seemingly simple, common truths. But, believe me, first of all, they are important in terms of preventing cholecystitis.

Interviewed by Igor Chichinov

The editors recommend:

Biliary dyskinesia: what is hidden for this diagnosis?
Why do people turn yellow?
MRI of the liver: pros and cons

For information:

Patrushev Nikolay Borisovich

Gastroenterologist, candidate of medical sciences 9002 7
Graduate of the Perm State Institute 1988
Primary Specialization in Gastroenterology – 1995
From 2005 to 2014 worked at the Central Research Institute of Gastroenterology (Moscow). First – a doctor in the department of chronic liver diseases, then the head of the consultative and diagnostic department of the institute.
Since 2020 – a gastroenterologist at the “Expert Clinic” Perm.
Accepts at the address: Perm, st. Monastyrskaya, 42a.

Cholecystocardiac syndrome. What is Cholecystocardiac Syndrome?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Cholecystocardial syndrome is a symptom complex characterized by a change in normal cardiac activity against the background of dysfunction of the gallbladder or biliary tract. The disease is manifested by cardialgia, arrhythmia and impaired conduction of the heart, which occur at the peak of biliary (hepatic) colic or exacerbation of cholecystitis. Diagnosis is based on data from a physical examination, ultrasound of the heart, gallbladder and ducts, ECG, blood tests. The basis of conservative therapy is dietary nutrition, the appointment of antispasmodic and choleretic drugs. Surgical treatment involves laparoscopic or open cholecystectomy.

ICD-10

K81 Cholecystitis

• Causes
• Pathogenesis
• Symptoms
• Complications
• Diagnostics
  • Differential diagnosis
• Treatment of cholecystocardiac syndrome
• Prognosis and prevention
• Prices for treatment

General

Cholecystocardial syndrome (cholecystitis heart, cholecystocoronary syndrome, cholecystocardial syndrome) – a set of metabolic and functional disorders of the myocardium, resulting from the negative impact on the heart muscle of pathological processes in the biliary system. The prevalence of the disease in chronic acalculous cholecystitis is 25-57%, in cholelithiasis – 15%. The variability of statistical indicators is associated with the difficulty in recognizing and conducting differential diagnosis of pathology. In women, the disease occurs 3 times more often than in men. The average age of patients is 35-55 years.

Cholecystocardial syndrome

Causes

The disease develops against the background of pathological processes in the gallbladder and biliary tract:

• acute and chronic acalculous or calculous cholecystitis;
• stenosis of the final section of the common bile duct as a result of stenosing papillitis, neoplasms of the Vater papilla, etc.

Cholecystocardial syndrome occurs in individuals with a history of coronary heart disease, arrhythmias, chronic heart failure, hypertension. The catalyst for the development of the syndrome can be biliary colic or an attack of cholecystitis, accompanied by intense pain.

Pathogenesis

Pathogenetic aspects of cholecystocardiac syndrome are the subject of controversy among scientists around the world. In modern gastroenterology, there are several interrelated and equivalent theories of the development of the disease:

• Reflex. According to this theory, inflammatory diseases of the biliary system have a pathological effect on the autonomic nervous system (parasympathetic, sympathetic), causing reflex arrhythmias, spasm of the arteries of the heart, etc.
• Metabolic. As a result of frequent exacerbations of cholecystitis and cholelithiasis, metabolism (electrolytes, carbohydrates, lipids, proteins, etc.) is disturbed. Changes in metabolic processes lead to inhibition of metabolic reactions in the myocardium.
• Infectious-toxic. Bacterial toxins released during exacerbation of the pathology of the biliary system (cholangitis, cholecystitis, cholelithiasis) have a cardiotropic effect. Under conditions of homeostasis disturbance and severe intoxication, dystrophic changes in the myocardium of toxic origin develop.

Symptoms

Most often, clinical manifestations occur after alcohol intake, dietary errors, and strong psycho-emotional stress. The symptomatology of the disease has a different degree of severity. Most often, the syndrome manifests itself as an acute paroxysmal, squeezing or stabbing pain in the region of the heart, radiating to the left hypochondrium, scapula, shoulder. Painful sensations occur in the midst of an exacerbation of cholecystitis or cholelithiasis. Aching, squeezing pains to the left of the sternum may be the only manifestation of the pathology of the biliary system.

There is a painless form of cholecystitis heart, in which the main symptom is a violation of the heart rhythm (atrial fibrillation, extrasystole, AV blockade). Arrhythmia in cholecystocardiac syndrome is associated with the onset of biliary colic and is practically not treatable with antiarrhythmic drugs. The disease is often combined with tachycardia, increased blood pressure, shortness of breath.

On the part of the biliary system, there are severe pains in the right hypochondrium, impaired stool, nausea, vomiting with bile, fever. When a calculus obstructs the lumen of the biliary duct, the main symptoms are accompanied by yellowness of the skin and sclera.

Complications

The consequences of cholecystocardial syndrome are associated with complications of the diseases that caused this pathology. An intense attack of cardialgia can lead to the development of cardiogenic shock, loss of consciousness, and death. Various arrhythmias in the absence of treatment against the background of the existing heart pathology cause fatal arrhythmias (fibrillation and ventricular flutter) up to asystole.

Reflex spasm of the coronary vessels may be complicated by the development of acute coronary syndrome, and prolonged ischemia of the heart muscle – myocardial infarction. On the part of the biliary system, it is possible to perforate the gallbladder with a calculus with the development of peritonitis and sepsis. When an infection joins, an empyema of the gallbladder occurs.

Diagnostics

The absence of pathognomonic signs, the blurring of the clinical picture causes significant difficulties in verifying the diagnosis. The search for an optimal diagnostic algorithm is of interest to doctors of various specialties (therapists, gastroenterologists, surgeons, etc.). To establish an accurate diagnosis, a comprehensive study of the cardiovascular and biliary systems is prescribed:

• Specialist inspection. Most often, the patient turns to a doctor of a narrow specialization (cardiologist, gastroenterologist), depending on the nature of the prevailing symptoms. The specialist finds out the history of life and illness, performs a physical examination, draws attention to the connection between the onset of an attack of cardiac pain or arrhythmia and an exacerbation of cholecystitis or biliary colic.
• Diagnostics of the biliary system. To study the biliary tract, ultrasound of the gallbladder and biliary tract is performed. In the presence of gallstone disease, endoscopic retrograde cholangiopancreatography (ERCP) is performed. In controversial and severe cases, magnetic resonance cholangiography is used.
• Examination of the cardiovascular system. To exclude the pathology of the heart, an ECG is performed, which may show extrasystole, impaired conduction along the legs of the His bundle, atrioventricular blockade of varying degrees, T-wave inversion. In some cases, 24-hour Holter ECG monitoring is performed. ECHO-KG allows to exclude organic lesions of the heart (defects, myocardial infarction, etc.)
• Blood test. With an exacerbation of cholecystitis in the blood, the number of leukocytes, the level of bilirubin increases, and the ESR accelerates. To exclude myocardial infarction, the level of CPK, CPK-MB, troponin, LDH, LDH-1 is determined.

Differential

Differential diagnosis of cholecystocardial syndrome is carried out with the pathology of the cardiovascular system: coronary heart disease, arrhythmias of another origin, myocardial infarction. With a painless form with a predominance of asthenoneurotic syndrome, the disease should be distinguished from vegetative-vascular dystonia. In differential diagnosis, the onset of cardiac pain, their duration and connection with the appearance of complaints from the gallbladder and biliary ducts is of great importance.

Treatment of cholecystocardiac syndrome

Therapeutic tactics depend on the patient’s condition, the severity of cardiac symptoms and the type of pathology of the biliary system. Currently, two main treatment options are being considered:

• Conservative. It is indicated for acalculous cholecystitis with rare (1-2 times a year) exacerbations, in the presence of stones in the bladder no larger than 10 mm in size, while maintaining its function and patency of the cystic duct. Conservative therapy is used in severe somatic condition of the patient to improve health. All patients are recommended a strict diet, limiting the consumption of fatty, fried foods, alcoholic and carbonated drinks. Ursodeoxycholic acid preparations are prescribed, which act on calculi, gradually dissolving them. For small stones, non-invasive shock wave lithotripsy is performed.
• Operational. It is used with the ineffectiveness of conservative therapy, large sizes of the calculus and unfavorable course of cholecystitis. Surgical manipulations are open or laparoscopic removal of the gallbladder. With severe decompensation of cardiac activity, surgical treatment is performed in two stages. First, one-stage decompression and sanitation of the gallbladder is performed. Then, after pain relief and stabilization of the patient’s condition, cholecystectomy is performed.

Prognosis and prevention

The prognosis of cholecystocardial syndrome depends on the severity of cardiac manifestations and the severity of diseases of the biliary tract. With the timely relief of cardiac pathology, the removal of inflammation and the operation, the prognosis is favorable. Complications that have developed as a result of diagnostic errors can lead to an unfavorable and sometimes fatal outcome.