Syncope caused by iatrogenic hyperkalemia.
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.
Giancaspro
Giuseppe
G
Department of Emergency and Urgency, Sapienza University, Azienda Policlinico Umberto I, Rome, Italy. giuseppe.giancaspro@uniroma1.it
Suppa
Marianna
M
Genuini
Igino
I
Caselli
Stefano
S
Fedele
Francesco
F
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
D047228:Angiotensin II Type 1 Receptor Blockers; D002411:Cation Exchange Resins; D004232:Diuretics; D019808:Losartan