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Indian Journal of Emergency Medicine 12(3):p 145-147, July - Sept. 2026. | DOI: https://doi.org/10.21088/ijem.2395.311X.12326.4
Case Report
The Silent Gallbladder, The Slowing Heart: Cope’s Sign in Acute Calculous Cholecystitis
Goonja Bhattacharya, Anita Rawat, Kishalay Datta
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Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
Indian Journal of Emergency Medicine 12(3):p 145-147, July - Sept. 2026. | DOI: https://doi.org/10.21088/ijem.2395.311X.12326.4
How Cite This Article:
Goonja Bhattacharya, Anita Rawat, Kishalay Datta. The Silent Gallbladder, The Slowing Heart: Cope’s Sign in Acute Calculous Cholecystitis. Ind J Emerg Med. 2026; 12(3): 145-147.Timeline
Received : May 08, 2026
Accepted : June 12, 2026
Published : September 30, 2026
Abstract
Cholelithiasis typically presents with right upper quadrant abdominal pain, nausea, and vomiting. However, atypical presentations may occur due to autonomic reflexes. One such rare manifestation is bradycardia resulting from the cardio-biliary reflex, also known as Cope’s sign. We report the case of a 45-year-old male presenting with acute right hypochondrial and epigastrict pain associated with marked sinus bradycardia (heart rate 42/min). Initial cardiac evaluation was unremarkable. Further abdominal imaging revealed cholelithiasis with features of acute cholecystitis. Following definitive management, the patient’s heart rate normalized. This case highlights the importance of recognizing extra-cardiac causes of bradycardia and underscores the clinical relevance of the cardio-biliary reflex in gallbladder pathology.
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Data Sharing Statement
There are no additional data available. All raw data and code are available upon request.
Funding
This research received no funding.
Author Contributions
All authors contributed significantly to the work and approve its publication.
Ethics Declaration
This article does not involve any human or animal subjects, and therefore does not require ethics approval.
Acknowledgements
We would like to express our gratitude to the patients, their families, and all those who have contributed to this study.
Conflicts of Interest
No conflicts of interest in this work.
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Cite this article
Goonja Bhattacharya, Anita Rawat, Kishalay Datta. The Silent Gallbladder, The Slowing Heart: Cope’s Sign in Acute Calculous Cholecystitis. Ind J Emerg Med. 2026; 12(3): 145-147.
Licence:
Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
| Received | Accepted | Published |
|---|---|---|
| May 08, 2026 | June 12, 2026 | September 30, 2026 |
DOI: https://doi.org/10.21088/ijem.2395.311X.12326.4
Keywords
Calculous CholecystitisCope’s SignGall Bladder StoneBradycardiaSearch for Similar Articles
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Timeline
| Received | May 08, 2026 |
| Accepted | June 12, 2026 |
| Published | September 30, 2026 |
licence
Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
