title: Syncope caused by iatrogenic hyperkalemia.
abstract: Symptomatic bradycardia in the emergency department may have several causes (excessive vagal tone, drug toxicity, acute myocardial ischemia, sick sinus syndrome, heart block, and electrolyte imbalance); among these, hyperkalemia may develop as a complication of chronic medical treatment with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, and must be considered in the early approach to the bradyarrhythmic patient with possible electrocardiographic signs of hyperkalemia. We report a case of an 87-year-old woman with a clinical history of chronic angiotensin-receptor blocker consumption that led her to dangerous bradyarrhythmia, cardiogenic syncope, and risk of sudden cardiac death.
authors.affiliation: Department of Emergency and Urgency, Sapienza University, Azienda Policlinico Umberto I, Rome, Italy. giuseppe.giancaspro@uniroma1.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giancaspro
authors.forename: Marianna
authors.initials: M
authors.lastname: Suppa
authors.forename: Igino
authors.initials: I
authors.lastname: Genuini
authors.forename: Stefano
authors.initials: S
authors.lastname: Caselli
authors.forename: Francesco
authors.initials: F
authors.lastname: Fedele
mesh_terms: D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects*; D001919:Bradycardia / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D002411:Cation Exchange Resins / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004232:Diuretics / Q000627:therapeutic use; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D007049:Iatrogenic Disease; D019808:Losartan / Q000009:adverse effects*; D013575:Syncope / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D002411:Cation Exchange Resins; D004232:Diuretics; D019808:Losartan