Quintero-Narváez JL, Pinilla-Jácome MA, Morera-Herrera AF

Language: Spanish
References: 12
Page: 132-137
PDF size: 446.37 Kb.

ABSTRACT

Introduction: BRASH syndrome (bradycardia, renal failure, atrioventricular block, shock, and hyperkalemia) is an emerging entity in emergency medicine. Its pathophysiology may mask other critical conditions such as ST-elevation myocardial infarction (STEMI).
Objective: to describe the clinical presentation and progression of a patient with BRASH syndrome associated with an evolved ST‑segment elevation myocardial infarction (STEMI), in order to analyze the diagnostic and therapeutic challenges encountered during the multidisciplinary management of the case.
Methods: a descriptive clinical case report was conducted. Clinical information was obtained through a retrospective review of the patient’s medical record and laboratory studies at Hospital Regional de Sogamoso E.S.E. A literature search was carried out in databases such as PubMed. Because the patient had died at the time of manuscript preparation, it was not possible to obtain informed consent for publication. All clinical information was thoroughly de‑identified to ensure that the patient cannot be reasonably recognized, in accordance with privacy and confidentiality standards for case reports.
Case reports are not considered human subjects research and therefore do not require Institutional Review Board approval.
Results: the patient received comprehensive management for hyperkalemia and bradycardia, achieving transient recovery of sinus rhythm. However, persistent ST-segment elevation confirmed an evolved STEMI. Despite pharmacological therapy and advanced support, she developed progressive hemodynamic instability and died from refractory cardiogenic shock.
Conclusion: BRASH syndrome may delay the diagnosis of STEMI by altering clinical presentation and electrocardiographic findings. Early recognition and comprehensive management are crucial to improve outcomes in emergency settings.

REFERENCES

1. Vishnu VK, Jamshed N, Amrithanand VT, Thandar S. BRASH Syndrome:A Case Report. J Emerg Med. 2021 Jun;60(6):818-822.doi: 10.1016/j.jemermed.2021.01.033. Epub 2021 Feb 24. PMID:33640217.

2. Shah P, Gozun M, Keitoku K, Kimura N, Yeo J, Czech T, et al.Clinical characteristics of BRASH syndrome: systematic scopingreview. Eur J Int Med. 2022;103:57–61. https://doi.org/10.1016/j.emjim.2022.06.002.

3. Gebray HM, Abeje AE, Boye AT. BRASH syndrome with a completeheart-block- a case report. BMC Cardiovasc Dis. 2024;24(1):171.https://doi.org/10.1186/s12872-024-03782-6

4. Saini TRJ, Al Hennawi H, Cox A, Janga C, DeLiana D, McCafreyJ. The vicious cycle of BRASH syndrome: A case report. Glob CardiolSci Practice. 2023:2.

5. Harris Majeed UK, Amin Moazzam Kan. BRASH syndrome: A systematicreview of reported cases current problems in Cardiologyjune 2023;48(6)

6. Farkas JD, Long B, Koyfman A, Menson K. BRASH Syndrome:Bradycardia, Renal Failure, AV Blockade, Shock, and Hyperkalemia.J Emerg Med. 2020;59(1):e39–e43. doi: 10.1016/j.jemermed.2020.05.001

7. Robert A Byrne, Xavier Rossello, J J Coughlan, Emanuele Barbato,Colin Berry, Alaide Chieffo, et al, ESC Scientific DocumentGroup , 2023 ESC Guidelines for the management of acute coronarysyndromes: Developed by the task force on the managementof acute coronary syndromes of the European Society of Cardiology(ESC), European Heart Journal, Volume 44, Issue 38, 7 October2023, Pages 3720–3826, https://doi.org/10.1093/eurheartj/ehad191

8. Rao SV, O’Donoghue ML, Ruet M, Rab T, Tamis-Holland JE,Alexander JH et al. 2025) ACCIAHA/ACEP/NAEMSP/SCAI Guidelinefor the Management of Patients With Acute CoronarySyndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical PracticeGuidelines. Circulation. 2025;151(13) https://doi.org/10.1161/CIR.0000000000001309D

9. Endramis G, Petrina SM, Baranchuk A. Not all ST-segment elevationsare myocardial infarction: Hyperkalemia and Brugadaphenocopy. Am J Emerg Med. 2017 Apr;35(4):662.e1-662.e2. doi:

10. 10.1016/j.ajem.2016.10.063.10. Yan GX, Antzelevitch C. Cellular basis for the Brugada syndromeand other mechanisms of arrhythmogenesis associated withST-segment elevation. Circulation 1999;100:1660–6.

11. Weiss JN, Qu Z, Shivkumar K. Electrophysiology of hypokalemiaand hyperkalemia. Circ Arrhythm Electrophysiol 2017;10:e004667

12. Hasnie AA, Baniahmad O, Tolwani A, McElderry HT, Prabhu SD.Complete heart block without ventricular escape secondary tohyperkalemia induced by herbal tea. HeartRhythm Case Reports.2022;8(3):174-177. doi:10.1016/j.hrcr.2021.11.004.