T-wave depletion and bradycardia possibly secondary to acute pancreatitis: review of the literature.

Acute pancreatitis has frequently been reported to be associated with transient electrocardiography changes mimicking myocardial infarction despite normal epicardial coronary arteries. Although the origin of these findings is poorly understood, suggested mechanisms have included electrolyte abnormalities, a vagally mediated reflex, coronary vasospasm, and myonecrosis because of the release of pancreatic proteolytic enzymes. We report a case of acute pancreatitis with new-onset electrocardiography changes and bradycardia despite no evidence of coronary artery disease. After resolution of inflammation in the pancreas, T-wave depletions in V1-V6 derivations in electrocardiography disappeared and the rhythm was sinus with 70/min. 201-Tl myocardial perfusion scintigraphy revealed no evidence of significant coronary artery disease.