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Botkin Syndrome

Botkin Syndrome

Botkin Syndrome Meaning:

Botkin Syndrome is complication of several diseases that characterized by several clinical symptoms. Many doctors figure it by the heartburns or Cardialgia.

Specially if it comes to the heart. You will notice many disturbances in the rhythm and the conductivity.

Sometimes, people with such syndrome are already suffering from atrial fibrillation, in fact, later on it will be the cause of a breath shortness.

The main cause of such syndrome is the pathological process of the gallbladder, which has toxic and reflector actions on the myocardium.

History of Botkin Syndrome:

The name comes from the first patient who suffered from this syndrome, in 1883, Botkin has complained about the assaults in the side of the heart,and feeling of disturbance of its rhythm.

The clinical diagnosis proved that he had a combination between gallbladder disease and stenocardia’s pains.

Symptoms of Botkin Syndrome:

Early signs:

Patients in this stage will have light common signs. It’s something to worry about :

  • Fatigue or weakness.
  • food intolerances, bloating, and belching.
  • Nausea, feeling discomfortable. 
  • Dizziness or lightheadedness.
  • In extreme cases, collapse.

Late signs: Such signs are so serious and more specific and can be considered fatal.

  • Pyrosis, a pain in the upper central abdomen or central chest, sometimes it rises to the neck and the arms.
  • Dyspnea, it’s a term that describes breath shortness, which can turn into asthma.
  • Arrhythmia: You will feel an improper heart beating. Sometimes Slow and fast beating.
  • Dizziness or lightheadedness.
  • Fainting or near-fainting spells.
  • Jaundice, it’s the discoloration of the skin caused by the buildup of bilirubin in the blood.


Etiology of Botkin Syndrome:


Diseases of the bile secreting ducts:

  • Chronic acalculous cholecystitis: It’s a Long term illness of the Gallbladder, the term of “Acalculous” is meant without stones or cystic duct obstruction, which are made by calculi accumulation.


    • Chronic calculous cholecystitis: It’s the inflammation of the gallbladder, most of the time resulting from a gallbladder stone blocking the cystic duct, also characterized by long periods of attacks and pain.

One of their common symptoms: fever tendress in the upper right quadrant of the stomach, clay-colored stools, yellowing of the skin.

  • Acute calculous cholecystitis: It’s less in the severity than the chronic form, but still dangerous, we can define it as an inflammatory disease of the gallbladder with evidence of gallstones or cystic duct obstruction.

People with such disease will suffer from a sudden sharp pain in the upper right side of your tummy (abdomen) that spreads towards your right shoulder.

Also it can be called “bilious colic”.

  • Pancreatitis with portal hypertension: Chronic pancreatitis can cause an obstruction in the splenic outflow, which causes an increase in the blood tension in the portal vein.


Pathogenesis of Botkin Syndrome:

At the emergency department, ussually they put people with pain in the right upper quadrant in the list of critical questions.

This syndrome always leads to thickening of gallbladder wall thickening by many hypothesized mechanisms.

One of them is an increase in portal vein tension, and a decrease in plasma oncotic pressure, congestive heart failure with bilateral pulmonary effusions.

There are some signs of many severe spasms of the sphincters Of lyutkensa, Mirizzi, Oddi and the expansion of bilious ducts with biliar hypertension.

The phenomenon of reflector influence is one of the explination of those signs.

It’s the influence of the afferent pathologic pulsation, which emanates from extra and intramural nervous interlacements on the bile-secreting ducts.

 The sympathetic and parasympathetic nerve fibers influence the heart, causing the spasm of coronary vessels, the disturbance of rhythm giving the feeling of stenocardia.


Heart influences:

The heart goes into a dystrophic change on the myocardium.

Such changes can be explained by the effect of the prolonged course of the gallbladder disease with the frequent attacks of the biliary colic.

The complications of chronic recurrent cholecystitis: associated with disturbances of the functions of the liver and the pancreas.

This Disbalances causes a perturbation in the hormones and in the electrolytic, enzyme and carbohydrate balance. Which can lead to the disturbances of the cardiovascular system.

Increased excitability, disturbances of conductivity and contracting ability of myocardium can be noticed.

Ischemic diseases and stenocardia makes unfavorable to the flow of Botkin Syndrome.


Clinical pictures of Botkin Syndrome:

  • 79% of the patients commonly have a combination between stenocardia and botkin syndrome.


Pain characteristics:

  • 85% of the patients have a sharp pain
  • 65% of the patients have compressing pain.
  • 13-58% of the patients have a splitting light pain.
  •  Pain will irradiate from the right subcostal area into the leftist and into the region of the heart.

Arrhythmias of heart :

  • 0,47 of the cases have Ectopic rhythms.
  • 9,6% to 13,9% of cases have extrasystole.
  • 3,5% to 13,5% will suffer from fibrillation arrhythmia.


Diagnosis of Botkin Syndrome:

Connection with Ischemic Heart Disease :

Botkin Syndrome is characterized by acute pain in the region of the heart. It appearance is connected with the viscero-viscero reflex on the vagus nerve.

Pain always appears in the right subcostal area. Always irradiates to the heart region.

The patient can indicate the location of pain by its finger.

The pain is always accompanied by dyspeptic phenomena.

This phenomenon can be defined as feeling full earlier than expected when eating.

That’s why Botkin Syndrome can be recognized with pain during eating, physical load or Jaundice.


Connection with Nervous system:

Botkin Syndrome always causes vegetative dysfunction, you can notice the predominance of the parasympathetic tone ( rest nerve).

Patients with Botkin syndrome will complain with acute myocardial ischemia.

After a period it will lead to the asthenoneurotic phenomena.

The Combination of those diseases will cause vegeto-vascular dystonia.

Such Dysfunction is characterized by palpitations, chest pain, hypertension or hypotension, chronic fatigue, difficulties sleeping, emotional lability, anxiety, diarrhoea or constipation and dyspepsia.

Connection with Blood:

  • Leukocytosis
  • Neutrophilia
  • fast ESR= Erythrocyte sedimentation rate.
  • Bilirubinemia
  • Hyperglycemia
  • Increasing in amylase.

Method of Diagnosis:

Botkin Syndrome

  • Cholecystography
  • Choleography
  • X-Ray
  • ECG


Application of “ Cholecystectomy ” : It is a surgical method of treatment that will definitely remove the gallbladder. It is a type of an open surgery using a laparoscope (a fiber-optic instrument)


Botkin Syndrome is a very serious condition.

it always influence in the cardiac system that leads always to heart failure.

Always contact your health provider if you feel such problem.

Jaundice: it’s a health condition characterized by a yellowish skin color.

This pathology known by excessive accumulation of direct bilirubin in blood.

Such disease can be the cause of hepatic, gallbladder disease or even sometime tumors. The tumors can do mecanical block of the bilirubin pathway.

ECG: This is a method to detect your heart electrical signals to give us general look about its health.



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