S3582 When Gallstones Imitate a Heart Attack: A Rare Cardiac Manifestation of Pancreatitis

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 man 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.