Acute Calculous Cholecystitis With Sinus Bradycardia: Cope's Sign Encountered

Acute cholecystitis and cardiac ischemia can have a similar clinical presentation in some patients. Nonspecific electrocardiographic changes and arrhythmias can occur in acute cholecystitis and gallbladder disease that can confuse the treating physician leading to extensive cardiac workup. Emergency physicians and cardiologists should be aware of these changes so they can expedite the management of acute cholecystitis, which can lead to the resolution of these changes. We report a case of a 53-year-old male who presented with diffuse abdominal pain, nausea, and vomiting. His ECG showed sinus bradycardia. Imaging confirmed the diagnosis of acute calculous cholecystitis. His cardiac workup was unremarkable. His sinus bradycardia was resolved with the management of acute cholecystitis. This case highlights the possibility of a "cardio-biliary reflex" that is initiated by gallbladder pain via autonomic vagal innervation.