Junctional bradycardia with verapamil in renal failure - care required even with mild hyperkalaemia

Hegazi, Mohamed Osama; Aldabie, G; Almutairi, Saleh; Sayed, Amin El

doi:10.1111/j.1365-2710.2012.01352.x

Cited by 22 publications

(15 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although in a rare number of cases, such changes might be absent, but usually the absence of such findings in a patient with hyperkalemia and severe junctional bradycardia favors an additional etiology of the bradycardia. e synergism of hyperkalemia with negative dromotropic agents, resulting in bradycardia, is well defined with multiple case reports highlighting such findings in patients on verapamil [18,19]. We propose that ranolazine can produce a similar effect, thereby leading to a syndrome analogous to BRASH.…”

Section: Discussionmentioning

confidence: 84%

Ranolazine Induced Bradycardia, Renal Failure, and Hyperkalemia: A BRASH Syndrome Variant

Zaidi

Shaikh

Saad

et al. 2019

Case Reports in Medicine

View full text Add to dashboard Cite

Ranolazine is a well-known antianginal drug, that was first licensed for use in the United States in 2006. It was objectively shown to improve exercise capacity and to lengthen the time to symptom onset in patients with coronary artery disease. The most commonly reported side effects of ranolazine include dizziness, headache, constipation, and nausea. Here, we describe a case of bradycardia, hyperkalemia, and acute renal injury in the setting of ranolazine use. Our patient is an 88-year-old female who presented with abdominal pain, nausea, and vomiting. Her medical comorbidities included hypertension, diabetes, CAD, heart failure with preserved ejection fraction, paroxysmal atrial fibrillation, hypothyroidism, and a history of cerebrovascular accident without any residual deficits. Her prescription regimen included amlodipine, furosemide, isosorbide mononitrate, levothyroxine, metformin, omeprazole, and ranolazine. Physical examination was remarkable for bradycardia and decreased breath sounds in the left lower lung field. Laboratory studies were significant for a serum potassium level of 6.8 mEq/L and a serum creatinine level of 1.6 mg/dL. She was given insulin with dextrose, sodium polystyrene, and calcium gluconate in addition to fluids. Her bradycardia and renal function worsened over the next 24 hours. Ranolazine was discontinued. Metabolic derangements were treated appropriately. After 48 hours from presentation, potassium and renal function returned to baseline and her heart rate improved to a range of 60–100 bpm. She was discharged with an outpatient cardiology follow-up. Ranolazine treatment was not continued upon discharge. In summary, our case illustrates an association between ranolazine and renal failure induced hyperkalemia, leading to conduction delays in the myocardium. Though further studies are warranted, we suspect that this is a variant of the recently described BRASH syndrome. We propose that in cases such as ours, along with treatment of the hyperkalemia, medication review and removal of any offending agent should be considered.

show abstract

Section: Discussionmentioning

confidence: 84%

Ranolazine Induced Bradycardia, Renal Failure, and Hyperkalemia: A BRASH Syndrome Variant

Zaidi

Shaikh

Saad

et al. 2019

Case Reports in Medicine

View full text Add to dashboard Cite

show abstract

“…It contains characteristic effects of both hyperkalemia and AV nodal blocker toxicity. Studies have shown that verapamil, a CCB, in the presence of mild hyperkalemia, can accentuate AV conduction delay, leading to junctional bradycardia [3][4]. Thus, significant symptomatic bradycardia can be seen without the typical EKG changes seen in severe hyperkalemia such as a wide QRS or peaked T waves [2].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with BRASH syndrome develop renal failure that leads to hyperkalemia. This has a synergistic effect with AV node blockers, i.e., BB and CCB, with the subsequent development of profound hypotension and bradycardia [3][4]. A key characteristic of BRASH syndrome is mild hyperkalemia causing significant bradycardia without other, typical electrocardiogram (EKG) changes (i.e., widening QRS, peaked T-waves).…”

Section: Introductionmentioning

confidence: 99%

Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalemia (BRASH) Syndrome as a Presentation of Coronavirus Disease 2019

Prabhu¹,

Hsu²,

Lestin³

et al. 2020

Cureus

View full text Add to dashboard Cite

The novel coronavirus disease 2019 (COVID-19) has led to a global pandemic. While acute respiratory failure has been the predominant concern, there have been reports of other endorgan damage such as renal failure. We report a case of an elderly woman who presented with BRASH syndrome, a constellation of bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia (BRASH), which was likely triggered by COVID-19.

show abstract

“…It was noticed that many clinicians have not clearly mentioned this clinical presentation as BRASH syndrome. Nine cases were identified in seven different studies [2][3][4][5][6][7][8]. The age of presentation ranged between 24 and 97 years with the mean age of 72 years.…”

Section: Discussionmentioning

confidence: 99%

Bradycardia, Renal Failure, Atrioventricular-nodal Blocker, Shock, and Hyperkalemia Syndrome Diagnosis and Literature Review

Sattar

Bareeqa

Rauf

et al. 2020

Cureus

View full text Add to dashboard Cite

The combination of bradycardia, renal failure, atrioventricular (AV)-nodal blocker medications, shock, and hyperkalemia (BRASH) is a new syndrome that is a consequence of a positive loop of bradycardia due to AV-nodal blockers and hyperkalemia secondary to renal insufficiency. We present a case of BRASH syndrome in which the patient on chronic AV-nodal blockers presented with bradycardia, hypotension, underlying kidney dysfunction, and hyperkalemia. The patient was medically managed and discharged upon clinical improvement. The purpose of this report is to highlight the rare cases of BRASH syndrome and improve its management.

show abstract

Junctional bradycardia with verapamil in renal failure - care required even with mild hyperkalaemia

Cited by 22 publications

References 8 publications

Ranolazine Induced Bradycardia, Renal Failure, and Hyperkalemia: A BRASH Syndrome Variant

Ranolazine Induced Bradycardia, Renal Failure, and Hyperkalemia: A BRASH Syndrome Variant

Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalemia (BRASH) Syndrome as a Presentation of Coronavirus Disease 2019

Bradycardia, Renal Failure, Atrioventricular-nodal Blocker, Shock, and Hyperkalemia Syndrome Diagnosis and Literature Review

Contact Info

Product

Resources

About