Cholecystitis and coronary artery disease are both common and frequent diseases in middle-aged and elderly people. Many patients have both diseases, gallstone cholecystitis and coronary heart disease, so it is easy to confuse whether the attack of coronary heart disease is caused by coronary artery disease or cholecystitis. Therefore, when a patient has an attack of angina pectoris, whether it is of biliary or cardiac origin is not only something that the patient is anxious to clarify, but also something that the doctor should distinguish. A, biliary coronary heart disease pathogenesis 1, abnormal lipid metabolism This is the same susceptibility factors in the etiology of cholelithiasis and coronary heart disease. The increase of blood lipids, especially cholesterol, is the basis for the formation of cholelithiasis and atherosclerosis. Secondly, obesity, diabetes, low activity, excessive consumption of animal fat or cholesterol-rich food are all common predisposing factors. 2, biliary hypertension and nerve reflexes As the heart and gallbladder sensory nerves cross at the fourth and fifth thoracic nerves and overlap at the fifth to eighth thoracic nerves, when the pressure in the bile duct increases, the bile duct spasms, or the impulses generated by bile acid salt stimulation, indirect contraction of the coronary vessels is caused by the vagus nerve through the spinal homunculus reflex; coronary blood flow decreases, myocardial contraction is somewhat inhibited, and The reduction of coronary blood flow, the inhibition of myocardial contraction, and the decrease of blood pressure can further reduce the coronary blood flow, which eventually leads to myocardial hypoxia and thus induces angina pectoris and arrhythmia, which is the main mechanism of the development of biliary heart syndrome. 3, biliary tract infection Biliary tract infection has serious interference with myocardial metabolism, mainly focusing on two aspects, one is the impact of the infection factor itself, and the other is the indirect effect caused by impaired liver function. The damage to myocardium from infection is not only the direct effect of bacterial toxins, but also the effects of temperature, electrolytes, circulating blood volume, internal environmental pH, abnormal osmotic pressure and disturbances in energy metabolism. Water-electrolyte disturbances due to biliary tract disease, especially hypokalemia, are a common cause of clinical ECG changes. 4, biliary colic inflammatory stimulation of the gallbladder can lead to variable cardiovascular effects, especially years of the presence of stone cholecystitis, when the lesion has developed to a certain extent, despite the standardized treatment with antibiotics, but the size of the gallbladder, wall thickness without significant changes, to consider this stage of coronary heart disease may be caused by cholecystitis. Inflammation and pain can reflexively cause heart rate to slow down, blood pressure to drop, and coronary artery blood supply to decrease, thus causing a series of changes in the ECG. In addition, elderly patients themselves mostly have the basis of coronary artery disease, and coupled with the influence of biliary tract disease, they are more likely to develop biliary heart syndrome. Clinical manifestations and treatment 1. precordial pain Its nature may be similar to that of coronary angina, but it often occurs after a full meal and lasts for a long time. 2, arrhythmia Many patients with biliary tract disease feel palpitations due to arrhythmia. Clinically, sinus arrhythmias and pre-term contractions are common, and occasionally atrial fibrillation and paroxysmal supraventricular tachycardia may be induced, but when biliary tract disease is cured, the above arrhythmias may disappear. In addition to arrhythmias, about 1/3 of patients may have non-specific ST-segment depression and T-wave hypoplasia or inversion. Any biliary patient with the above cardiovascular manifestations, which cannot be explained by other causes and the persistence of gallbladder inflammation, should consider biliary heart syndrome. Treatment: Biliary heart syndrome often occurs with the acute attack of biliary tract disease, and it can disappear automatically after the remission of biliary tract disease, so the main treatment is the primary disease, and the cardiovascular manifestations of biliary tract disease can generally be treated without special treatment. For patients with conservative treatment, in addition to cholestatic therapy and effective antibiotics, the calcium antagonist nifedipine should also be selected for treatment. For patients with intractable gallbladder inflammation, cholecystectomy can be considered, and angina pectoris basically disappears after surgery in patients with biliary heart syndrome.