Trina L. Mathew, DO, Gabriel Gonzales, DO, Long Hoang, DO; Medical City Fort Worth, Fort Worth, TX
Introduction: When you think of acute pancreatitis you may think of a few classic symptoms: severe abdominal pain that radiates to the back, nausea and vomiting. But when a patient comes in with symptomatic bradycardia and vague abdominal discomfort, would you think of pancreatitis? Here is why you should.
Methods: Our patient is a forty-six year old female who presented with complaints of dizziness and mild left upper quadrant abdominal pain. She was noted to be bradycardic with a heart rate of twenty three. She was subsequently given two doses of atropine with initial improvement in her heart rate; however, she became bradycardic two more times and required additional doses of atropine for each of these events. Cardiology was consulted and interviewed her in the emergency room. Treatment options were discussed including obtaining an electrophysiologist consult and the possibility of requiring a pacemaker for symptomatic bradycardia of unknown origin. The decision was made to admit her into the hospital for further evaluation. With a concerning heart rate prone to progressive bradycardia, she was sent to the intensive care unit for close evaluation with atropine, pacer pads and the crash cart in close proximity. Upon further interview, patient attributed her left upper quadrant pain to the takeout she ate a couple of days before admission. She described it as a colicky, intermittent pain on the left side of her abdomen which did not radiate to her back. She had taken a number of TUMS prior to admission without relief. She denied diarrhea, nausea, vomiting or fever. She denied any significant cardiac history, chest pain or palpitations. She felt lightheaded and presyncopal that morning but did not lose consciousness. She underwent thorough work up in the intensive care unit and lab results revealed a lipase of 3,413. CT of the abdomen revealed stranding in the mesentery surrounding the uncinate process and head of the pancreas. There was a small amount of fluid extending along the tail of the pancreas and into the left pericolic gutter consistent with acute pancreatitis. With treatment of her underlying pancreatitis, her bradycardia resolved and she was later discharged home. Discussion: This case illustrates a form of viscero-visceral reaction which could lead providers astray in making the initial diagnosis. Although this presentation of pancreatitis is rare, it is not uncommon for autonomic dysfunction to be a presenting sign of an underlying disorder in an otherwise healthy individual.
Disclosures: Trina Mathew indicated no relevant financial relationships. Gabriel Gonzales indicated no relevant financial relationships. Long Hoang indicated no relevant financial relationships.