# The Cardio-Biliary Reflex in Gallbladder Disease: A Case Report and Literature Review

## TL;DR

A case report shows how gallbladder issues can cause heart rhythm changes, highlighting the importance of recognizing this connection in diagnosis.

## Contribution

This case report adds to the understanding of the cardio-biliary reflex in gallbladder disease and its clinical implications.

## Key findings

- Biliary colic can induce significant cardiac rhythm changes via the cardio-biliary reflex.
- Pain management alone can resolve bradycardia linked to gallbladder pathology.
- Clinicians should consider the cardio-biliary reflex in diagnosing bradyarrhythmia with abdominal pain.

## Abstract

This case report describes an elderly female presenting with simultaneous biliary colic and symptomatic sinus bradycardia. The resolution of her bradycardia with pain management alone suggested Cope’s sign, or the cardio-biliary reflex (CBR), as the underlying cause. This reflex is a well-recognized physiological response in which gallbladder pathology triggers vagal nerve signals, potentially causing significant alterations in cardiac rhythm and often mimicking primary heart conditions. This case illustrates that even uncomplicated biliary colic can induce this effect and emphasizes the importance for clinicians to consider this reflex in the differential diagnosis of bradyarrhythmia accompanied by abdominal pain. Recognizing CBR is crucial for directing management toward the correct biliary pathology and avoiding unnecessary cardiac investigations or interventions.