De novo ECG changes in patients without a history of heart problems presenting with acute cholecystitis: etiology and clinical importance

Keshtkar Rajabi, Shahin; Dalirani, Shadab; Azh, Nima; Motamedgorji, Nogol; Abbasi, Mohammad Amin

doi:10.61186/rabms.11.2.186

Volume 11, Issue 2 (4-2025) Journal of Research in Applied and Basic Medical Sciences 2025, 11(2): 186-192 | Back to browse issues page

‎ 10.61186/rabms.11.2.186

Ethics code: IR.IUMS.REC.1399.434

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Keshtkar Rajabi S, Dalirani S, Azh N, Motamedgorji N, Abbasi M A. De novo ECG changes in patients without a history of heart problems presenting with acute cholecystitis: etiology and clinical importance. Journal of Research in Applied and Basic Medical Sciences 2025; 11 (2) :186-192
URL: http://ijrabms.umsu.ac.ir/article-1-401-en.html

De novo ECG changes in patients without a history of heart problems presenting with acute cholecystitis: etiology and clinical importance

Shahin Keshtkar Rajabi

, Shadab Dalirani

, Nima Azh

, Nogol Motamedgorji

, Mohammad Amin Abbasi ^*

Firoozabadi Clinical Research Development Unit, School of Medicine, Iran University of Medical Sciences, Tehran, Iran , amin.abbasi1314@gmail.com

Abstract: (261 Views)

Background & Aims: Acute cholecystitis, primarily an inflammatory condition of the gallbladder, has been associated with electrocardiographic (ECG) changes that mimic cardiac pathology. While laparoscopic cholecystectomy is a well-established treatment for acute cholecystitis, its potential impact on postoperative ECG changes in patients without pre-existing cardiovascular disease remains unclear. This study aims to investigate the incidence and nature of ECG alterations following laparoscopic cholecystectomy in patients without prior cardiac disease.
Materials & Methods: In this single-arm cohort study, we reviewed 75 patients who underwent laparoscopic cholecystectomy for acute cholecystitis at Firouzabadi General Hospital between March 2020 and March 2021. Patients with pre-existing cardiac conditions or abnormal preoperative ECGs were excluded. A 12-lead ECG was performed within 48 hours before and 24 hours after surgery. ECGs were analyzed by a cardiologist and an internist, and discrepancies were resolved through consensus. The difference in the incidence of postoperative ECG changes was assessed using McNemar’s Chi-Square test.
Results: Among the 75 patients included (mean age: 47.38 ± 13.16 years, 74.7% female), four patients (5.3%) had benign T-wave inversions before surgery. Following surgery, 13 patients (17.3%) exhibited new ECG changes, including T-wave inversions (precordial: 5, limb leads: 5) and ST-segment depressions (precordial: 1, limb leads: 2). McNemar’s Chi-Square test indicated a statistically significant increase in ECG changes postoperatively (p = 0.012). All patients were discharged without persistent ECG abnormalities or major postoperative complications.
Conclusion: This study suggests a potential association between laparoscopic cholecystectomy and transient ECG alterations in patients without prior cardiac disease. Proposed mechanisms include gallbladder manipulation, sympathetic adrenergic stimulation, and laparoscopy-induced hemodynamic stress. Future studies with larger cohorts and control groups undergoing non-biliary laparoscopic surgeries are needed to delineate the effects of cholecystectomy from those of laparoscopy itself on cardiac electrophysiology.

Keywords: Acute cholecystitis, Electrocardiographic changes, Laparoscopic cholecystectomy, Postoperative cardiac monitoring, Sympathetic stimulation

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Type of Study: orginal article | Subject: Internal Medicine Specialist

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