Transthyretin Cardiac Amyloidosis Presenting as Bradycardia, Renal Failure, Atrioventricular-Nodal Blockade, Shock, and Hyperkalemia (BRASH) Syndrome: A Case Report

Nazima Khatun; Bernard Brown; Jonathan Francois; Adam S Budzikowski; Louis Salciccioli; Sabu John

doi:10.7759/cureus.44532

Transthyretin Cardiac Amyloidosis Presenting as Bradycardia, Renal Failure, Atrioventricular-Nodal Blockade, Shock, and Hyperkalemia (BRASH) Syndrome: A Case Report

Cureus. 2023 Sep 1;15(9):e44532. doi: 10.7759/cureus.44532. eCollection 2023 Sep.

Authors

Nazima Khatun¹, Bernard Brown¹, Jonathan Francois², Adam S Budzikowski³, Louis Salciccioli³, Sabu John⁴

Affiliations

¹ Department of Internal Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA.
² Department of Cardiology, State University of New York Downstate Medical Center, Brooklyn, USA.
³ Department of Cardiology, State University of New York Downstate Health Sciences University, Brooklyn, USA.
⁴ Department of Cardiology, Kings County Hospital Center, Brooklyn, USA.

Abstract

BRASH syndrome involves the chain of events resulting from the collective effects of Bradycardia, Renal failure, Atrioventricular (AV)-nodal blockade, Shock, and Hyperkalemia. BRASH syndrome can rapidly progress to cardiac arrest. Early recognition is crucial. We present a case of transthyretin cardiac amyloidosis (ATTR-CA) in an elderly woman who presented with BRASH syndrome shortly after an AV-nodal blocker was prescribed for atrial fibrillation.

Keywords: bradycardia renal failure av nodal blocker; brash syndrome; heart failure; shock; transthyretin cardiac amyloidosis.

Publication types

Case Reports