In clinical practice, we often encounter some patients who visit the doctor for chest tightness and chest pain, and the electrocardiogram reveals myocardial ischemia, according to which the doctor diagnoses angina pectoris, especially in middle-aged and elderly people, most of whom are diagnosed as coronary heart disease. 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, dysfunctional heart activity and abnormal electrocardiogram caused by biliary tract diseases, especially gallbladder stones, without organic lesions in the heart muscle itself, the severity of which 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, which is the bile heart reflex. 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, and further decreased coronary blood flow, which eventually leads to myocardial ischemia and hypoxia, resulting in precordial discomfort, pain, panic, chest tightness, and A series of symptoms and abnormal ECG changes such as precordial discomfort, pain, panic, chest tightness, arrhythmia and so on. If the patient has coronary artery disease, the myocardial ischemia and hypoxia will be more serious. 2. Toxic and electrolyte disturbances First, due to the presence of infection and biliary hypertension, bacterial toxins are absorbed, which has a damaging effect on the myocardium. 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, cholelithiasis combined with coronary artery disease, or with common factors of coronary artery disease are more likely to develop arrhythmias. 3, other mechanisms In biliary tract infection, impaired liver function leads to hyperbilirubin, hyperbilirubinemia, which can stimulate the vagus nerve, causing vagal reflexes, inhibiting cardiomyocyte energy metabolism and diastolic function of the heart, biliary obstruction, bile reflux, which can cause biliary pancreatitis, producing pancreatic enzyme toxemia, leading to myocarditis, the cardiovascular system has a variety of endocrine functions, such as myocardial inhibitory factors, increased biliary pressure, etc. Factors may cause the heart to produce MDF directly or through neural mediators, further aggravating myocardial damage. Second, the focus of treatment should be on the gallbladder. 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 frequent chest tightness and 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, and if the effect of drug treatment is not good, recurrent biliary heart syndrome patients should undergo cholecystectomy. Clinical practice proves that after this disease is cured by medical or surgical treatment of biliary diseases, the coronary heart symptoms can often be cured by themselves, and the electrocardiogram will gradually return to normal. The following five conditions should be alerted to biliary heart syndrome: 1, biliary disease manifests first, heart disease signs later, biliary heart syndrome often occurs when there is 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.