{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:28:58Z","timestamp":1786739338251,"version":"build-2736575974"},"reference-count":8,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2020,10,1]],"date-time":"2020-10-01T00:00:00Z","timestamp":1601510400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:p>We report a case of a 28-year-old male who presented in the emergency room with a history of two episodes of syncope in the last 3 days at home. ECG was done in the emergency room which was suggestive of complete heart block. The patient had a history of pain on and off in the right upper quadrant region (RUQ) after having a meal. Ultrasonography of the abdomen was advised which revealed acute calculous cholecystitis. A temporary pacemaker was inserted and an emergency laparoscopic cholecystectomy was planned. The patient recovered postoperatively and converted back to sinus rhythm. Considering the patient's age, normal cardiac workup, and his complete heart block disappeared after the removal of his gallbladder, it was postulated that this patient had a case of cardio-biliary reflex (Cope's sign).<\/jats:p>","DOI":"10.4103\/jfmpc.jfmpc_919_20","type":"journal-article","created":{"date-parts":[[2020,10,30]],"date-time":"2020-10-30T06:48:16Z","timestamp":1604040496000},"page":"5375-5377","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Cope's sign: A lesson for novice physicians"],"prefix":"10.4103","volume":"9","author":[{"given":"Rakesh K.","family":"Ola","sequence":"first","affiliation":[{"name":"Department of Cardiology, Noble Care Hospital, Sikar, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indira","family":"Sahu","sequence":"additional","affiliation":[{"name":"Department of Pathology, SMS Medical College and Hospital, Jaipur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manish","family":"Ruhela","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Noble Care Hospital, Sikar, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Smriti","family":"Bhargava","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, SK Medical College and Hospital, Sikar, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,10]]},"reference":[{"key":"R1-20260528","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.jemermed.2003.10.001","article-title":"Electrocardiographic manifestations: Diagnosis of atrioventricular block in the emergency department","volume":"26","author":"Hayden","year":"2004","journal-title":"J Emerg Med"},{"key":"R2-20260528","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1136\/bmj.325.7365.639","article-title":"Acute cholecystitis","volume":"325","author":"Indar","year":"2002","journal-title":"Br Med J"},{"key":"R3-20260528","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1097\/MEJ.0b013e32832baed8","article-title":"Complete atrioventricular block in a patient with acute cholecystitis: A case of cardio-biliary reflex?","volume":"16","author":"Franzen","year":"2009","journal-title":"Eur J Emerg Med"},{"key":"R4-20260528","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1136\/bmj.3.5715.147","article-title":"A sign of gall -bladder disease","volume":"3","author":"Cope","year":"1970","journal-title":"Br Med J"},{"key":"R5-20260528","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.ijcard.2014.12.153","article-title":"Asystole complicating acalculous cholecystitis, the \u201cCope's sign\u201d revisited","volume":"182","author":"Lau","year":"2015","journal-title":"Int J Cardiol"},{"key":"R6-20260528","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1001\/jama.1967.03120160063006","article-title":"Preoperative use of atropine and electrocardiographic changes. Differentiation of ischemic from biliary-induced abnormalities","volume":"200","author":"Kaufman","year":"1967","journal-title":"JAMA"},{"key":"R7-20260528","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1097\/MEJ.0b013e32832baed8","article-title":"Complete atrioventricular block in a patient with acute cholecystitis: A case of cardio-biliary reflex?","volume":"16","author":"Franzen","year":"2009","journal-title":"Eur J Emerg Med"},{"key":"R8-20260528","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1001\/archinte.159.6.625","article-title":"Neurally mediated syncope in 2 patients with extracardiac disease","volume":"159","author":"Vloka","year":"1999","journal-title":"Arch Intern Med"}],"container-title":["Journal of Family Medicine and Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_919_20","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T19:28:09Z","timestamp":1786735689000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_919_20"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10]]},"references-count":8,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_919_20","relation":{},"ISSN":["2249-4863","2278-7135"],"issn-type":[{"value":"2249-4863","type":"print"},{"value":"2278-7135","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10]]},"assertion":[{"value":"2020-05-19","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-24","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}