Pseudo-Wellens' syndrome and intermittent left bundle branch block in acute cholecystitis

We present a case of a 54-year-old male patient who was admitted to our Emergency Department (ED) with localized epigastric pain. Inflammation markers, ultrasound, and CT scan were inconsistent with an initial diagnosis of cholecystitis. However, there was additional evidence of cholecystolithiasis. The ECG showed new anterior biphasic T waves typical for a Wellens' type A ECG. Additionally, the patient had an intermittent left bundle branch block (LBBB). The diagnostic challenges in differentiating possible diagnoses will be described, to which in this case, were either acute cholecystitis or acute coronary syndrome (ACS). A laparoscopic study confirmed acute cholecystitis. Coronary angiography showed no pathological processes associated with ACS. ECG abnormalities were initially ongoing, but were no longer detectable during an 8 month follow up assessment.