In clinical practice, we often encounter patients who visit the doctor for chest tightness and chest pain, and the electrocardiogram reveals myocardial ischemia, and the doctor diagnoses angina pectoris accordingly. In fact, the cause of chest pain in some people is not in the heart, but in the gallbladder, and when these people undergo gallbladder removal surgery, the above symptoms do not appear, and this disease is medically known as biliary heart syndrome. A. Chest pain, the root of the disease is in the gallbladder Gallbladder heart syndrome was first proposed by a Russian expert in 1977, which refers to the clinical syndrome of insufficient coronary artery blood supply, heart activity disorders and electrocardiogram abnormalities caused by biliary tract diseases, especially gallbladder stones, while the heart muscle itself has no organic lesions, and its severity is positively correlated with the condition of biliary tract diseases. Why does cholecystitis cause chest tightness and chest pain? There are three possible reasons for this. 1, bile heart reflex: due to the existence of cross innervation of the nerves of the gallbladder and the heart, the gallbladder suffers from stimulation, which can cause heart discomfort. Specifically, the heart is innervated by the thoracic 2-8 nerves, while the gallbladder, the common bile duct is innervated by the thoracic 4-9 nerves, and the two cross at the 4 and 5 spinal nerves. Therefore, when there is chronic inflammation in the biliary system, which increases the pressure in the common bile duct, it can act upon the heart through the crossed thoracic 4 and 5 nerve reflex, causing coronary vasoconstriction, decreased coronary blood flow, inhibition of myocardial contraction, decreased heart beat blood volume, decreased blood pressure, further reducing coronary blood flow, which eventually leads to myocardial ischemia and hypoxia, resulting in precordial discomfort, pain, panic, chest tightness, A series of symptoms and abnormal ECG changes such as precordial discomfort, pain, panic, chest tightness, and arrhythmia. If the patient has coronary artery disease, the myocardial ischemia and hypoxia will be more serious. 2, toxin and electrolyte disorders: First, due to the presence of infection and biliary hypertension, bacterial toxins are absorbed, which has a damaging effect on the heart muscle. Secondly, infection also affects body temperature, electrolytes and acid-base balance. Electrolyte disturbances, especially hypokalemia, have a significant impact on the myocardium and are a common cause of clinical electrocardiographic changes. Third, elderly people with cholecystitis, gallstone disease combined with coronary artery disease, or with common factors of coronary artery disease are more likely to develop arrhythmias. 3, other mechanisms: biliary tract infection, impaired liver function leads to hyperbilirubin, hyperbile acidemia, can stimulate the vagus nerve, causing vagal reflex, inhibit the energy metabolism of cardiomyocytes and the diastolic function of the heart, biliary obstruction, bile reflux, can cause biliary pancreatitis, produce pancreatic enzyme toxemia, leading to myocarditis, the cardiovascular system has a variety of endocrine functions, such as myocardial inhibitory factors, increased biliary pressure Factors may cause the heart to produce MDF directly or through neural mediators, further aggravating myocardial damage. Once a patient with biliary heart syndrome is diagnosed, the focus of treatment should be on biliary tract disease, such as anti-infection, anti-inflammatory and biliary and application of antispasmodic agents. Patients with biliary heart syndrome with chest tightness and frequent chest pain can choose calcium antagonists, such as nifedipine, 5-10 mg each time, taken orally three times a day, to prevent and alleviate the signs of heart disease, the effect of drug treatment is not good, recurrent biliary heart syndrome patients should perform cholecystectomy. Clinical practice proves that after the disease is cured by medical or surgical treatment of biliary diseases, the symptoms of coronary heart disease can often be cured by itself, and the electrocardiogram will gradually return to normal. (a) The following five conditions, be alert to biliary heart syndrome: 1, biliary disease manifested first, heart disease signs later, when the occurrence of biliary heart syndrome is often an acute attack of biliary disease, such as inflammation and pain in the gallbladder region. 2, similar to angina pectoris phenomenon lasts for a long time, usually 15 minutes to several hours, taking nitroglycerin, quick-acting heart pills and other coronary expansion drugs drugs, chest pain is not easy to relieve. 3.The effect of internal medicine treatment is not significant. 4.The symptoms of heart disease improve or worsen simultaneously with the improvement or aggravation of biliary tract disease. 5.Electrocardiogram has no abnormal changes except for arrhythmia and myocardial ischemia. (2) The following three conditions can be diagnosed as biliary heart syndrome: 1, the presence of chronic inflammatory disease of the biliary tract combined with precordial pain and abnormal ECG changes, after surgical treatment of biliary tract disease, precordial pain and ECG abnormalities disappear. 2, biliary tract disease acute attack of cardiac dysfunction, and electrocardiogram abnormalities can not be explained by other factors. 3.Patients with heart disease combined with biliary tract disease, without the application of cardiovascular drugs, only after the application of drugs to control biliary tract inflammation, the two diseases remit at the same time.