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Chowdhury T, Pokhriyal SC, Gupta U, Kunwar K, Hashmi K, Devkota S, Kopyt M, Sherazi A. Bradycardia, Renal Failure, Atrioventricular Block, Shock, and Hyperkalemia (BRASH) Syndrome Emergence in a Unique Intersection of COVID-19 and End-Stage Renal Disease: A Case Report. Cureus 2024; 16:e54695. [PMID: 38524089 PMCID: PMC10960575 DOI: 10.7759/cureus.54695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Bradycardia, renal failure, atrioventricular (AV) block, shock, and hyperkalemia (BRASH) syndrome is a rare clinical entity that poses challenges for healthcare practitioners. It is characterized by bradycardia, renal failure, atrioventricular (AV) obstruction, shock, and hyperkalemia. This case is an interesting instance of BRASH syndrome in the setting of COVID-19 infection and end-stage renal disease (ESRD). Initial laboratory results revealed macrocytic anemia, renal dysfunction, acidosis, and mild hyponatremia, along with hyperkalemia. An electrocardiogram (EKG) and telemonitoring showed dopamine-resistant persistent bradycardia until transvenous temporary pacemaker placement was done, which resolved the bradycardia. Anti-hyperkalemic therapy, avoiding AV nodal-blocking medication, and temporary pacemaker placement were all part of the management. After receiving hemodialysis, the patient gradually recovered. Bradycardia improved and potassium normalized. The intricate interaction between hyperkalemia and AV nodal obstruction that causes BRASH syndrome results in severe bradycardia and shock. To the best of our knowledge, this is the first case of BRASH syndrome in a patient with an active COVID-19 infection in a previously vaccinated patient. Even though case reports make up the majority of the material currently in publication, to fully comprehend the mechanisms underlying this illness, more research is required, as early detection of this syndrome is crucial for better patient outcomes.
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Affiliation(s)
- Tutul Chowdhury
- Internal Medicine, One Brooklyn Health-Interfaith Medical Center, Brooklyn, USA
| | - Sindhu C Pokhriyal
- Internal Medicine, One Brooklyn Health-Interfaith Medical Center, Brooklyn, USA
| | - Uma Gupta
- Internal Medicine, One Brooklyn Health-Interfaith Medical Center, Brooklyn, USA
| | - Kalendra Kunwar
- Internal Medicine, One Brooklyn Health-Interfaith Medical Center, Brooklyn, USA
| | - Kiran Hashmi
- Internal Medicine, One Brooklyn Health-Interfaith Medical Center, Brooklyn, USA
| | - Sauraj Devkota
- Internal Medicine, One Brooklyn Health-Interfaith Medical Center, Brooklyn, USA
| | - Morris Kopyt
- Internal Medicine, One Brooklyn Health-Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Andleeb Sherazi
- Critical Care, One Brooklyn Health-Interfaith Medical Center, Brooklyn, USA
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Hussain A, Ahmed N, Marlowe S, Piercy J, Kommineni SS. A Case of Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalaemia (BRASH) Syndrome in an Elderly Male and Its Management: A Case Report and Literature Review. Cureus 2023; 15:e49489. [PMID: 38152818 PMCID: PMC10751601 DOI: 10.7759/cureus.49489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
BRASH syndrome, characterized by bradycardia, renal dysfunction, atrioventricular (AV) nodal blockage, shock, and hyperkalemia, is a rare but potentially life-threatening condition resulting from the interplay between AV nodal blockers and hyperkalemia. This complex syndrome poses significant challenges in diagnosis and management, with patients often presenting with bradycardia and high potassium levels. This case report highlights the need for increased awareness of BRASH syndrome, especially in an aging population and evolving cardiovascular treatments. Early recognition and a comprehensive, multidisciplinary approach are crucial for improving outcomes in affected patients.
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Affiliation(s)
- Akbar Hussain
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
| | - Nazneen Ahmed
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
| | - Stanley Marlowe
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
| | - Jonathan Piercy
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
| | - Sai S Kommineni
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
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Ghallab M, Noff NC, Sandhu J, El-Ijla A, Makhoul K, Sahibzada A, Munira M. A Case Report of BRASH (Bradycardia, Renal Failure, Atrioventricular (AV) Blockage, Shock, and Hyperkalemia) Syndrome With a Challenging Diagnosis and Management Dilemma. Cureus 2023; 15:e46413. [PMID: 37927773 PMCID: PMC10621626 DOI: 10.7759/cureus.46413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
BRASH syndrome, characterized by bradycardia, renal failure, atrioventricular (AV) blockage, shock, and hyperkalemia, is an emerging clinical entity that challenges healthcare practitioners. This case report presents a unique instance of BRASH syndrome with an atypical presentation in a 56-year-old woman with a past medical history of hypertension, diabetes, and chronic kidney disease. Initial laboratory results revealed severe normocytic anemia, thrombocytopenia, renal dysfunction, acidosis, and hyponatremia, alongside hyperkalemia and hypothyroidism. An electrocardiogram depicted sinus arrest with atrial escape rhythms, indicative of severe bradycardia. Imaging studies revealed pleural effusion and ground glass opacities. Management involved anti-hyperkalemic measures, discontinuation of AV nodal-blocking agents, thyroid hormone replacement, and vasopressor support. The patient eventually improved following continuous renal replacement therapy (CRRT) and hemodialysis. The diagnosis of BRASH syndrome emerged as the most likely due to recurrent admissions with similar clinical features. BRASH syndrome represents a complex interplay between AV nodal block and hyperkalemia, leading to severe bradycardia and shock, often affecting older patients with limited renal reserve. While the current literature primarily consists of case reports, raising awareness of BRASH syndrome is crucial for timely intervention and improved patient outcomes. Further research is needed to better understand the mechanisms underlying this syndrome.
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Affiliation(s)
- Muhammad Ghallab
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals, Queens, New York, USA
| | - Nicole C Noff
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals, Queens, New York, USA
| | - Jasmine Sandhu
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals, Queens, New York, USA
| | - Alli El-Ijla
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals, Queens, New York, USA
| | - Karim Makhoul
- Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals, Queens, New York, USA
| | - Asad Sahibzada
- Pulmonary and Critical Care, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals, Queens, New York, USA
| | - Most Munira
- Cardiology/Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals, Queens, New York, USA
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Khatun N, Brown B, Francois J, Budzikowski AS, Salciccioli L, John S. Transthyretin Cardiac Amyloidosis Presenting as Bradycardia, Renal Failure, Atrioventricular-Nodal Blockade, Shock, and Hyperkalemia (BRASH) Syndrome: A Case Report. Cureus 2023; 15:e44532. [PMID: 37790068 PMCID: PMC10544653 DOI: 10.7759/cureus.44532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
BRASH syndrome involves the chain of events resulting from the collective effects of Bradycardia, Renal failure, Atrioventricular (AV)-nodal blockade, Shock, and Hyperkalemia. BRASH syndrome can rapidly progress to cardiac arrest. Early recognition is crucial. We present a case of transthyretin cardiac amyloidosis (ATTR-CA) in an elderly woman who presented with BRASH syndrome shortly after an AV-nodal blocker was prescribed for atrial fibrillation.
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Affiliation(s)
- Nazima Khatun
- Department of Internal Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Bernard Brown
- Department of Internal Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Jonathan Francois
- Department of Cardiology, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Adam S Budzikowski
- Department of Cardiology, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Louis Salciccioli
- Department of Cardiology, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Sabu John
- Department of Cardiology, Kings County Hospital Center, Brooklyn, USA
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Sharma M, Obi MF, Garg Y, Seetharam K, Cho HJ. A Case Report on Uremic Toxins and Their Effects on Cardiac Rhythm: Understanding Junctional Ventricular Escape Rhythm in Renal Failure. Cureus 2023; 15:e43302. [PMID: 37692585 PMCID: PMC10492656 DOI: 10.7759/cureus.43302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 09/12/2023] Open
Abstract
Understanding the reasons behind junctional ventricular escape rhythm is crucial for guiding the clinical management of patients. Various factors such as acidosis, hyperkalemia, metabolic toxins, digoxin toxicity, and BRASH syndrome (comprising bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia) should be considered when dealing with a symptomatic unstable patient in a hospital. In this case, we present an example where metabolic toxins, specifically uremia, in combination with other factors, lead the patient to enter a ventricular escape rhythm, ultimately resulting in cardiogenic shock. The main objective of this case study is to illustrate how uremic metabolic acidosis contributes to AV nodal blockade, leading to a junctional ventricular escape rhythm within the context of BRASH.
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Affiliation(s)
- Manjari Sharma
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
| | - Mukosolu F Obi
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
| | - Yash Garg
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
| | | | - Hyun Joon Cho
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
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Phuyal P, Moond V, Catahay JA, Caldararo M, Patel KV. When a Cure Becomes a Curse: The Complex Clinical Scenario Involving Amiodarone Therapy and BRASH (Bradycardia, Renal failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalemia) Syndrome. Cureus 2023; 15:e38622. [PMID: 37284357 PMCID: PMC10240549 DOI: 10.7759/cureus.38622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/08/2023] Open
Abstract
BRASH [bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia] syndrome is a recently recognized clinical condition that is rare but can be potentially life-threatening. Its pathogenesis is characterized by a self-perpetuating cycle of bradycardia that is potentiated by the concomitant occurrence of medication use, hyperkalemia, and renal failure. AV nodal blocking agents are commonly implicated in BRASH syndrome. We report a case of a 97-year-old female patient with a medical history of heart failure with preserved ejection fraction, atrial fibrillation, hypertension, hyperlipidemia, and hypothyroidism who presented to the emergency department with a one-day history of diarrhea and vomiting. Upon presentation, the patient was hypotensive, bradycardic, and had severe hyperkalemia, acute renal failure, and anion gap metabolic acidosis, raising concern for BRASH syndrome. The treatment of each component of BRASH syndrome resulted in the resolution of the symptoms. The association of BRASH syndrome with amiodarone, the only AV nodal blocking agent in this particular case, is not commonly reported.
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Affiliation(s)
- Prabin Phuyal
- Department of Internal Medicine, Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Vishali Moond
- Department of Internal Medicine, Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Jesus A Catahay
- Department of Internal Medicine, Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Mario Caldararo
- Department of Pulmonary and Critical Care Medicine, Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Keval V Patel
- Cardiology, Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
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Muacevic A, Adler JR, Gudiwada MCVB, Jitta SR. Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock and Hyperkalemia (BRASH) Syndrome: A Clinical Case Study. Cureus 2023; 15:e34803. [PMID: 36788997 PMCID: PMC9915857 DOI: 10.7759/cureus.34803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/11/2023] Open
Abstract
BRASH syndrome, which stands for Bradycardia, Renal failure, Atrioventricular (AV) Nodal blockade, and shock, is a relatively new clinical condition. Bradycardia develops because of the synergistic effect of AV-nodal blockers and hyperkalemia in a renal failure resulting in a vicious cycle of progressive bradycardia, renal hypoperfusion, and hyperkalemia. We present a case of an 88-year-old man with chronic systolic heart failure, atrial fibrillation, stage 3 chronic kidney disease, and dementia who presented to our emergency department with poor oral intake and weakness. He was found to have symptomatic bradycardia in the 30s secondary to hyperkalemia and beta-blockers in the setting of acute renal failure from dehydration, raising concern for BRASH syndrome. Treatment of each component conservatively resulted in complete resolution without the need for aggressive measures such as dialysis or pacing. This case report also discusses the pathophysiology, management, and the need for recognizing this underdiagnosed and novel clinical condition.
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Muacevic A, Adler JR, Kim A, Watat K, Banga S. Beta-Blocker and Calcium Channel Blocker Toxicity With BRASH Syndrome: A Case Report. Cureus 2023; 15:e33544. [PMID: 36779105 PMCID: PMC9907465 DOI: 10.7759/cureus.33544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Atrioventricular (AV) nodal blockers have a wide variety of medical uses, including the management of hypertension and cardiac arrhythmias. Like any other drug, they can carry side effects and toxicity. We present a case of a patient with a constellation of findings consistent with bradycardia, renal failure, AV nodal blockade, shock, and hyperkalemia (BRASH) syndrome. A 75-year-old female with a history of paroxysmal atrial fibrillation and heart failure with preserved ejection fraction presented to the hospital with shortness of breath. She was discharged two weeks prior to the presentation from another hospital after being treated for atrial fibrillation with a rapid ventricular response. She was discharged on metoprolol and diltiazem. Upon presentation to the hospital, the patient was noted to be bradycardic and hypotensive with blood work notable for acute kidney injury and hyperkalemia, consistent with BRASH syndrome. She received a dose of intravenous (IV) glucagon followed by infusion and received epinephrine infusion. Once clinically stable, she was discharged with her home dose of metoprolol and a reduced dose of diltiazem with a close follow-up with cardiology. Early recognition of BRASH syndrome as a unique clinical entity rather than different pathologic conditions is important to improve morbidity and mortality in these patients.
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Muacevic A, Adler JR, Agrawal H, Arko SB. A Case Report on BRASH (Bradycardia, Renal Failure, Atrioventricular Blockade, Shock, and Hyperkalaemia) Syndrome: A Challenging Diagnosis. Cureus 2022; 14:e32704. [PMID: 36686086 PMCID: PMC9848718 DOI: 10.7759/cureus.32704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 12/23/2022] Open
Abstract
A relatively new yet critical phenomenon of bradycardia, renal failure, atrioventricular (AV) blockade, shock, and hyperkalemia (BRASH) syndrome is hypothesized to happen in patients who take atrioventricular nodal blocking (AVNB) agents and have underlying renal insufficiency. In our case, a 67-year-old female with an extensive medical history presented to the emergency room with chief complaints of decreased appetite, nausea, vomiting, fatigue, and left-sided atypical chest pain for the past two weeks. The patient was taking losartan potassium 50 mg daily in addition to carvedilol 6.25 mg twice daily for her hypertension (HTN) and heart failure with reduced ejection fraction (HFrEF) with the addition of bumetanide 0.5 mg, which was added three weeks prior. On presentation, the patient had sinus bradycardia and hypotension along with the laboratory finding of acute kidney injury (AKI) in the setting of chronic kidney disease (CKD) and hyperkalemia. Cardiology and nephrology were consulted emergently; her clinical scenario raised suspicion of the BRASH syndrome. The patient was admitted to the intensive care unit (ICU), and all antihypertensive medications, including beta-blockers, were stopped. Intravenous (IV) fluid resuscitation and medical management of hyperkalemia were initiated, along with BiPAP for respiratory distress. She responded significantly, and her vitals remained stable. She was successfully discharged home with a cardiology and nephrology follow-up. We highlight the case to emphasize the consideration of BRASH in a patient on multiple cardiac medications who presented with deranged electrolytes and organ failure, and decompensated heart failure (HF) should not be fixed on as the principal diagnosis.
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Muacevic A, Adler JR, Hakobyan N, Sedeta E, Uche I, Wasifuddin M, Torere BE, Perry JC, Rafii SE. BRASH Syndrome Presenting With Idioventricular Escape Rhythm in a Patient With Trifascicular Block. Cureus 2022; 14:e32217. [PMID: 36620804 PMCID: PMC9812229 DOI: 10.7759/cureus.32217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Bradycardia, renal failure, atrioventricular (AV) nodal disease, shock, and hyperkalemia (BRASH) syndrome is a well-recognized constellation of distinct clinicopathologic entities comprising bradycardia, renal failure, AV nodal disease, shock, and hyperkalemia. Our patient is an 89-year-old female with a past medical history significant for hypertension and diabetes, who was newly started on labetalol and had recent gastroenteritis; she presented to our Emergency Department with bradycardia and shock. Upon presentation, she showed physical signs of volume depletion, and her blood pressure was 50 mmHg systolic and heart rate was 25 beats per minute. The initial electrocardiogram showed an idioventricular rhythm. The laboratory workup revealed hyperkalemia. The patient was given repeated doses of atropine with no significant response. She was resuscitated with isotonic fluids. The patient improved clinically, her blood pressure stabilized, her potassium level, renal function, and heart rate were normalized, and normal sinus rhythm was restored with a narrow QRS complex. A diagnosis of BRASH syndrome was made retrospectively. Overall, the treatment of this syndrome is largely symptomatic. Hemodynamic support with fluid and treatment of hyperkalemia remains the goal of care. The overall prognosis is good if identified early and managed appropriately.
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Muacevic A, Adler JR. The Role of Verapamil Toxicity in the Vicious Cycle of Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalemia (BRASH) Syndrome: A Case Report. Cureus 2022; 14:e32336. [PMID: 36514700 PMCID: PMC9733795 DOI: 10.7759/cureus.32336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
BRASH is an acronym describing the vicious cycle seen in patients taking atrioventricular (AV) nodal blockers who tend to present with bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia. Herein, we report the case of an 87-year-old hypertensive patient on verapamil who presented with complaints of fever and shortness of breath. She was found to have bradycardia, hyperkalemia, renal impairment, and borderline hypotension. Differentiating this case from previous case reports on BRASH syndrome, this patient was found to simultaneously have toxic levels of serum verapamil.
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Prabhu V, Hsu E, Lestin S, Soltanianzadeh Y, Hadi S. Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalemia (BRASH) Syndrome as a Presentation of Coronavirus Disease 2019. Cureus 2020; 12:e7816. [PMID: 32467792 PMCID: PMC7249758 DOI: 10.7759/cureus.7816] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/24/2020] [Indexed: 12/22/2022] Open
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.
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Affiliation(s)
- Vishaal Prabhu
- Emergency Medicine, Mount Sinai St. Luke's - Roosevelt Hospital Center, New York City, USA
- School of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, USA
| | - Edmund Hsu
- Emergency Medicine, Mount Sinai St. Luke's - Roosevelt Hospital Center, New York City, USA
| | - Stephan Lestin
- Emergency Medicine, Mount Sinai St. Luke's - Roosevelt Hospital Center, New York City, USA
| | - Yasamin Soltanianzadeh
- Emergency Medicine, Mount Sinai St. Luke's - Roosevelt Hospital Center, New York City, USA
| | - Sara Hadi
- Emergency Medicine, Mount Sinai St. Luke's - Roosevelt Hospital Center, New York City, USA
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Sattar Y, Bareeqa SB, Rauf H, Ullah W, Alraies MC. Bradycardia, Renal Failure, Atrioventricular-nodal Blocker, Shock, and Hyperkalemia Syndrome Diagnosis and Literature Review. Cureus 2020; 12:e6985. [PMID: 32201662 PMCID: PMC7075507 DOI: 10.7759/cureus.6985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Hiba Rauf
- Internal Medicine, Dow Medical College, Karachi, PAK
| | - Waqas Ullah
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
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