Biliary heart syndrome and biliary heart reflex Biliary heart syndrome is a clinical syndrome of insufficient coronary artery supply, dysregulation of cardiac activity and electrocardiographic abnormalities caused by biliary tract disorders. It is fundamentally different from the biliary heart reflex, but is intrinsically related to it. The pathogenesis of bile heart syndrome is that the heart is innervated by T2-8 spinal nerves, while the gallbladder and common bile duct are innervated by T4-9 spinal nerves, and the two cross at T4-5 spinal nerves. Therefore, when there is inflammation in the bile duct and the pressure in the bile duct increases, the reflexes of the T4-5 nerves cause the coronary arteries to constrict and blood flow to decrease, triggering the dysregulation of heart activity. In addition, bilirubin and bile acid are both excitatory substances of the vagus nerve. The pathogenesis of the bile heart reflex The bile heart reflex is the slowing of the heart rate, the drop in blood pressure and even cardiac arrest caused by the retraction of the gallbladder or the exploration of the biliary tract during biliary surgery. It is based on a complete reflex arc, in which the visceral nerve sensory fibers in the wall of the gallbladder are stimulated and the excitation is transmitted to the parasympathetic hypopolar center in the medulla oblongata (vagal spinal nucleus) via the afferent fibers in the left vagus nerve, releasing impulses to the heart via the parasympathetic fibers in the left vagus nerve. The intrinsic link between biliary heart syndrome and biliary heart reflexes Although the two are fundamentally different, they are intrinsically linked, i.e., the pathogenesis of both is based on the biliary heart reflex arc, and the occurrence of biliary heart reflexes is significantly increased in patients with biliary heart syndrome. Diagnosis of biliary heart syndrome 1.Biliary cyst disease combined with precordial pain and electrocardiogram abnormalities, after surgical removal of the gallbladder, precordial pain and electrocardiogram abnormalities can be diagnosed as this syndrome. 2, Cardiac dysfunction and ECG abnormalities during acute attacks of biliary disease, excluding the influence of biliary sepsis, acidosis, hypokalemia and other factors on cardiac function. 3.The cardiac dysfunction and ECG abnormalities that appear before and after surgery for obstructive jaundice cannot be explained by other factors can be diagnosed as biliary heart syndrome. Treatment of biliary heart syndrome Only surgical treatment of biliary heart syndrome can improve the secondary cardiac damage, and the following problems cannot be ignored: 1. Because of the possible toxic metabolic dysregulation in patients with severe infection, inflammation must be controlled first, metabolism must be improved, and the immunity of the body must be enhanced. 2. Preoperative cholinergic M-blockers such as atropine and 654-2 should be used routinely. 3. For patients over 55 years of age with precordial pain and ECG abnormalities, preoperative consultation with an internist should be requested, and strict intraoperative ECG monitoring and general anesthesia should be used as much as possible. 4, Intraoperative routine 1% procaine closure of the gallbladder triangle to reduce the occurrence of bile heart reflex. 5.If cardiac arrest occurs during the operation, subdiaphragmatic cardiac compressions should be performed immediately, and the airway should be kept open to complete cardiopulmonary resuscitation within a short time. Only by doing the above can the risk of surgery be reduced.