Jasti Jaswanth R, Jasty Tirumala Nischal, Gudiwada Mohan Chandra Vinay Bharadwaj, Jitta Sahas Reddy
Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA.
Internal Medicine, Tower Health Medical Group, Reading, USA.
Cureus. 2023 Feb 9;15(2):e34803. doi: 10.7759/cureus.34803. eCollection 2023 Feb.
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.
BRASH综合征，代表心动过缓、肾衰竭、房室结阻滞和休克，是一种相对较新的临床病症。心动过缓是由于肾衰竭时房室结阻滞剂和高钾血症的协同作用而发生的，导致心动过缓、肾灌注不足和高钾血症的恶性循环。我们报告一例88岁男性患者，患有慢性收缩性心力衰竭、心房颤动、3期慢性肾脏病和痴呆症，因口服摄入减少和虚弱前来我院急诊科就诊。在脱水导致急性肾衰竭的情况下，发现他因高钾血症和β受体阻滞剂而出现30多次有症状的心动过缓，这引发了对BRASH综合征的关注。对每个组成部分进行保守治疗后完全缓解，无需透析或起搏等积极措施。本病例报告还讨论了其病理生理学、管理以及认识这种诊断不足的新型临床病症的必要性。
