BRASH syndrome: a case report with full reversibility

Erika Lara-Pérez, Servicio de Cardiología Clínica, Hospital Juárez de México, Ciudad de México, México

BRASH syndrome is a recently described and likely underdiagnosed clinical entity characterized by the synergistic interaction between bradycardia, renal failure, hyperkalemia, and the use of atrioventricular nodal blocking agents, which may lead to significant hemodynamic instability. We report the case of a 70-year-old patient with chronic ischemic heart disease and heart failure who presented with severe clinical and metabolic deterioration. Initial evaluation revealed extreme bradycardia with a junctional rhythm and severe hyperkalemia in the setting of worsening renal function and treatment with a beta-blocker. The diagnostic and therapeutic approach is described, highlighting the importance of early recognition of this syndrome in order to initiate prompt treatment and avoid unnecessary interventions such as urgent pacemaker implantation.

Keywords: BRASH syndrome. Bradycardia. Hyperkalemia. Renal failure. Atrioventricular nodal blockers.