SHM Converge Scientific Abstract ePoster Gallery-Case of Complete Heart Block With Renal Failure and Shock

Pdf Summary

This case describes a 60-year-old man with chronic kidney disease, hypertension, and type 2 diabetes who was found unresponsive at work and presented in shock with severe bradycardia. He was taking carvedilol, nifedipine, spironolactone, and valsartan for resistant hypertension. Initial labs showed marked hyperkalemia (potassium 8.1) and acute kidney injury (creatinine 2.7). His ECG demonstrated complete heart block with a junctional escape rhythm, without the typical classic ECG signs of hyperkalemia.<br /><br />The patient did not respond to atropine, and transcutaneous pacing was ineffective. He required epinephrine and dopamine for hemodynamic support. Medical therapy was insufficient to correct the hyperkalemia, so he underwent urgent hemodialysis. After dialysis and correction of potassium, his bradycardia resolved.<br /><br />The authors highlight this as a classic presentation of BRASH syndrome, a syndrome characterized by bradycardia, renal failure, AV nodal blocker use, shock, and hyperkalemia. BRASH often develops when acute kidney injury, sometimes triggered by mild volume depletion or medications such as ACE inhibitors or ARBs, interacts with AV nodal–blocking drugs like carvedilol to create a vicious cycle of worsening bradycardia, renal dysfunction, hyperkalemia, and shock.<br /><br />The key lesson is that BRASH should be recognized early because treatment focuses on correcting hyperkalemia and supporting circulation, often requiring vasopressors and dialysis. Prompt diagnosis can prevent progression of the cycle and avoid a life-threatening outcome.

Asset Subtitle

Niharika Baviriseaty

Meta Tag

Author List Blake Brown, Niharika Baviriseaty, Vivek Mehta

Category Clinical Vignettes

Concept BRASH Syndrome

Concept Bradycardia

Concept Renal Failure

Concept Atrioventricular Nodal Blocker

Concept Shock

Concept Hyperkalemia

Distinguished Non-Finalist

Presenter Organization University of South Florida

Presenting Author Niharika Baviriseaty

Track Adult

Keywords

BRASH syndrome

hyperkalemia

bradycardia

acute kidney injury

shock

complete heart block

carvedilol

hemodialysis

AV nodal blocker

resistant hypertension

BRASH Syndrome

Bradycardia

Renal Failure

Atrioventricular Nodal Blocker

Shock

Hyperkalemia