Transient cardiac rhythm aberrancy in acute pancreatitis

The cardiovascular system is one of the commonly affected systems in various inflammatory and metabolic conditions, and rhythm abnormalities are most vulnerable in this context. Here, we are describing a rare presentation of acute pancreatitis, in which a young male appeared with cardiac rhythm irregularity. The patient presented with localized chest pain of recent onset and had a blood pressure of 88/54 mm Hg initially. On electrocardiogram (ECG), an accelerated idio-ventricular rhythm was identified with the absence of P wave and borderline QRS complex duration. However, his electrolytes were normal, qualitative troponin T was negative, echocardiography ruled out structural cardiac anomalies, and coronary arteries had no occlusion in angiogram. In the absence of any identifiable cause, the recent alcohol intake history made us to measure his serum amylase and lipase levels, and surprisingly, the levels were more than three times the upper value. Additionally, his ultrasound of the abdomen depicted bulky pancreatic head, and thus, the diagnosis of acute pancreatitis was made. Rhythm abnormality subsided with conservative management and the patient was discharged with a normal ECG. The case will shed some light on pancreatitis-associated acute cardiac rhythm abnormality, which is uncommon in emergency department.