https://doi.org/10.4081/ecj.2022.10566

A case of unstable bradycardia requiring comprehensive management in the emergency department: BRASH syndrome

Vol. 18 No. 3 (2022)
Submitted: 21 April 2022
Accepted: 11 August 2022
Published: 27 September 2022
Atrioventricular nodal blocker, bradycardia, hyperkalemia, renal failure, shock
Abstract Views: 550
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Authors

Sinan Genc
https://orcid.org/0000-0002-0516-1028
Ankara University School of Medicine Department of Emergency Medicine, Ankara, Turkey.
Omer Yusuf Erdurmus
yerdurmus@gmail.com
https://orcid.org/0000-0001-9160-7753
Ankara University School of Medicine Department of Emergency Medicine, Ankara, Turkey.
Abdullah Erhan
Ankara University School of Medicine Department of Emergency Medicine, Ankara, Turkey.
Ahmet Burak Oguz
https://orcid.org/0000-0001-8796-7529
Ankara University School of Medicine Department of Emergency Medicine, Ankara, Turkey.
Ayca Koca
Ankara University School of Medicine Department of Emergency Medicine, Ankara, Turkey.
Muge Gunalp Eneyli
https://orcid.org/0000-0001-8140-6720
Ankara University School of Medicine Department of Emergency Medicine, Ankara, Turkey.
Onur Polat
Ankara University School of Medicine Department of Emergency Medicine, Ankara, Turkey.

Bradycardia, renal failure, Atrioventricular (AV) nodal Blocker Drug Use, Shock, and Hyperkalemia (BRASH) syndrome is a clinical condition frequently seen in emergency services but with low diagnostic awareness. In cases of the syndrome, its cause was determined to be the synergistic effect of hyperkalemia due to renal failure and the use of AV nodal blocker drugs. The common features of patients diagnosed with BRASH syndrome are moderately elevated potassium levels and symptomatic bradycardia with various ECG findings (such as junctional bradycardia, atrioventricular block, and sinus bradycardia). Detection of these findings is very important in the diagnosis process. In this case report, we aimed to reveal the important points in the diagnosis of BRASH syndrome, ECG findings, and treatment approach.

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Europe PMC
Farkas JD, Long B, Koyfman A, Menson K. BRASH syndrome: bradycardia, renal failure, AV blockade, shock, and hyperkalemia. J Emerg Med 2020;59:216–23. DOI: https://doi.org/10.1016/j.jemermed.2020.05.001
Sattar Y, Bareeqa SB, Rauf H, et al. Bradycardia, renal failure, atrioventricular-nodal blocker, shock, and hyperkalemia syndrome diagnosis and literature review. Cureus 2020:12:e6985. DOI: https://doi.org/10.7759/cureus.6985
Sarkar S, Rapista N, Rout A, Chaudhary R. BRASH: Case report and review of literature. Hearts 2021;2:302–6. DOI: https://doi.org/10.3390/hearts2030025
Lizyness K, Dewald O. BRASH Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 May 30]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK570643/
Palmisano P, Accogli M, Zaccaria M, et al. Relationship between seasonal weather changes, risk of dehydration, and incidence of severe bradyarrhythmias requiring urgent temporary transvenous cardiac pacing in an elderly population. Int J Biometeorol 2014;58:1513–20. DOI: https://doi.org/10.1007/s00484-013-0755-7
Aziz EF, Javed F, Korniyenko A, et al. Mild hyperkalemia and low eGFR a tedious recipe for cardiac disaster in the elderly: an unusual reversible cause of syncope and heart block. Heart Int 2011;6:e12. DOI: https://doi.org/10.4081/hi.2011.e12
Hegazi MO, Aldabie G, Al-Mutairi S, El Sayed A. Junctional bradycardia with verapamil in renal failure--care required even with mild hyperkalaemia. J Clin Pharm Ther 2012;37:726–8. DOI: https://doi.org/10.1111/j.1365-2710.2012.01352.x
Comelli I, Lippi G, Mossini G, et al. The dark side of the QT interval. The Short QT Syndrome: pathophysiology, clinical presentation and management. Emerg Care J 2012;8:41–7. DOI: https://doi.org/10.4081/ecj.2012.3.41
Srivastava S, Kemnic T, Hildebrandt KR. BRASH syndrome. BMJ Case Rep 2020;13:e233825. DOI: https://doi.org/10.1136/bcr-2019-233825
Wong CK, Jaafar MJ. Bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia: An important syndrome to recognize. Turk J Emerg Med 2021;21:86–9. DOI: https://doi.org/10.4103/2452-2473.309138
Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation 2021;161:115–51. DOI: https://doi.org/10.1016/j.resuscitation.2021.02.010
Grigorov MV, Belur AD, Otero D, et al. The BRASH syndrome, a synergistic arrhythmia phenomenon. Proc Bayl Univ Med Cent 2020:33:668–70. DOI: https://doi.org/10.1080/08998280.2020.1784637
Váquez C, Huelmos A, Alegría E, et al. Verapamil deleterious effects in chronic renal failure. Nephron 1996;72:461–4. DOI: https://doi.org/10.1159/000188913

How to Cite

Genc, S., Erdurmus, O. Y., Erhan, A., Oguz, A. B., Koca, A., Eneyli, M. G., & Polat, O. (2022). A case of unstable bradycardia requiring comprehensive management in the emergency department: BRASH syndrome. Emergency Care Journal, 18(3). https://doi.org/10.4081/ecj.2022.10566

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