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Case Reports
. 2020 Jul 10;33(4):668-670.
doi: 10.1080/08998280.2020.1784637.

The BRASH syndrome, a synergistic arrhythmia phenomenon

Mladen V Grigorov  1 , Agastya D Belur  1 , Diana Otero  2 , Sirmad Chaudhary  1 , Evgeni Grigorov  3 , Shahab Ghafghazi  2
Affiliations
Case Reports

The BRASH syndrome, a synergistic arrhythmia phenomenon

Mladen V Grigorov et al. Proc (Bayl Univ Med Cent). .

Abstract

BRASH syndrome is a relatively novel clinical entity with profound bradycardia secondary to simultaneous metabolic derangement and drug toxicity. The syndrome is a clinical pentad of bradycardia, acute kidney injury, use of atrioventricular nodal blocking agents, shock, and hyperkalemia. It is widely underrecognized with selectively few reports, mainly in the elderly population. We present a 43-year-old woman on two oral atrioventricular blocking agents who presented with 1 week of increasing lethargy with rapid deterioration into cardiac arrest with subsequent shock postresuscitation. She was found to have hyperkalemia, metabolic acidosis, and acute kidney injury on arrival. Her initial electrocardiogram was remarkable for sinus arrest and junctional bradycardia. She was treated with a temporary pacemaker, renal replacement therapy, and potassium-lowering agents, with subsequent improvement resulting in conversion to normal sinus rhythm.

Keywords: Atrioventricular block; beta-blockers; bradycardia; sinus arrest.

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Figures

Figure 1.
Figure 1.
(a) Initial electrocardiogram depicting sinus arrest with junctional bradycardia. (b) Electrocardiogram after hyperkalemia correction depicting sinus rhythm.
Figure 2.
Figure 2.
The process of an initial renal hypoperfusion insult causing hyperkalemia, which synergizes with AV nodal blockers to cause bradycardia and a subsequent repeating cascade.
See this image and copyright information in PMC

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