Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Apr 24;12(4):e7816.
doi: 10.7759/cureus.7816.

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

Vishaal Prabhu  1   2 , Edmund Hsu  1 , Stephan Lestin  1 , Yasamin Soltanianzadeh  1 , Sara Hadi  1
Affiliations
Case Reports

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

Vishaal Prabhu et al. Cureus. .

Abstract

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 end-organ 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.

Keywords: av nodal blockers; bradycardia; brash syndrome; coronavirus disease 2019; hyperkalemia; renal failure; sars-cov-2 (severe acute respiratory syndrome coronavirus -2); shock.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Initial EKG - junctional rhythm at 45 bpm
EKG: electrocardiogram
Figure 2
Figure 2. Portable chest X-ray on presentation showing diffuse, hazy, ground-glass airspace disease
Figure 3
Figure 3. Previous chest X-ray from 2018 showing no acute pulmonary disease
Figure 4
Figure 4. Repeat EKG - normal sinus rhythm at 87 bpm
EKG: electrocardiogram
See this image and copyright information in PMC

References

    1. Cases of coronavirus disease (COVID-19) in the U.S. [Apr;2020 ];https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html 2020
    1. PulmCrit. BRASH syndrome: bradycardia, renal failure, AV blocker, shock, hyperkalemia. [Apr;2020 ];Farkas Farkas, J. J. https://emcrit.org/pulmcrit/brash-syndrome-bradycardia-renal-failure-av-... Retrieved April 13. 2016
    1. Junctional bradycardia with verapamil in renal failure - care required even with mild hyperkalaemia. Hegazi MO, Aldabie G, Al-Mutairi S, El Sayed A. J Clin Pharm Ther. 2012;37:726–728. - PubMed
    1. Verapamil and mild hyperkalemia in hemodialysis patients: a potentially hazardous association. Letavernier E, Couzi L, Delmas Y, Moreau K, Murcott O, Precigout V. Hemodial Int. 2006;10:170–172. - PubMed
    1. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Zhou P, Yang X, Wang X, et al. Nature. 2020;579:270–273. - PMC - PubMed

Publication types

LinkOut - more resources