Title: Corticosteroids-Induced Bradycardia: A Case Report & Literature Review
Authors: Ahmed Q. Hasan, MD and Dr Ahmed Al-Khazraji, MD
DOI: http://dx.doi.org/10.18535/jmscr/v4i7.64
Sinus corticosteroids-induced bradycardia with high dose steroids has been reported in literature. Although the association is still not clearly understood but several mechanisms have been prompted to explain causality. The authors had a case of 54 years female who presented with slurred speech and confusion that was noted while she was at work. In the emergency department the patient was hypotensive and hypoglycemic with no response to intravenous fluids hydration and was diagnosed with adrenal insufficiency. sepsis, bleeding and allergic reaction were ruled out. Her blood pressure improved on steroid therapy but she developed profound bradycardia with heart rate of 20 beat per minutes (BPM). Steroids-induced bradycardia was suspected and the patient`s heart rate improved after tapering off the steroids without the need for atropine or pacemaker. In this paper we are reporting a case of sinus bradycardia caused by corticosteroids and reviewing literature that focus on the association between corticosteroids and bradycaria and their causes. 1. Van der Gugten A, Bierings M, Frenkel J. Glucocorticoid-associated bradycardia. J Pediatr Hematol Oncol. 2008;30:172–5 2. Akikusa JD, Feldman BM, Gross GJ, Silverman ED, Schneider R. Sinus bradycardia after intravenous pulse methylprednisolone. Pediatrics. 2007;119: e778–82 3. Hsu DT. Steroids and bradycardia: how slow can you go? J Pediatr Hematol Oncol. 2008;30:119–20 4. Taylor M, Gaco D. Symptomatic sinus bradycardia after a treatment course of high-dose oral prednisone. J Emerg Med 2013;45:e55-8 5. Vasheghani-Farahani A, Sahraian M, Darabi L, et al. Incidence of various cardiac arrhythmias and conduction disturbances due to high dose intravenous methylprednisolone in patients with multi-ple sclerosis. J NeurolSci 2001;309:75-8 6. Al Shibli A, Al Attrach A, Hamdan M. Bradycardia following oral corticosteroid use: case report and literature review. Arab J Nephrol Transplant 2012;5:47-9 7. Ohlsson A, Heyman E. Dexamethasone-induced bradycardia. Lancet 1988;332: 1074 8. Pudil R, Hrncir Z. Severe bradycardia after a methylprednisolone “minipulse” treat-ment. Arch Intern Med 2001;161:1778-9 9. Bocanegra T, Castaneda M, Espinosa L, et al. Sudden death after methylprednisolone pulse therapy. Ann Intern Med 1981;95:122 10. Lucas K, Howrie D, Phebus C. Cardiorespiratory decompensation follo-wing methylprednisolone administration. PedHematolOncol 1993;10:249-55 11. Sinha A, Bagga A. Pulse steroid therapy. Ind J Ped 2008;75:1057-66 12. Gardiner P, Griffith I. Sudden death after treatment with pulsed methylprednisolone. BMJ 1990;300:125 13. Jasmine Stroeder. Corticosteroid-induced bradycardia. Canadian Pharmacists Journal / Revue des Pharmaciens du Canada September/October 2015 vol. 148 no. 5 235-240 14. Tvede N, Nielsen L, Andersen V. Bradycardia after high-dose intravenous methylprednisolone therapy. Scand J Rheumatol 1986;15:302-4 15. Naranjo CA, et al. "A method for estimating the probability of adverse drug reactions" Clin. Pharmacol. Ther. 1981;30 (2): 239–45 16. Klein-Gitelman MS, Pachman LM. Intravenous corticosteroids: adverse reactions are more variable than expected in children. J Rheumatol 1998;25:1995-2002 17. Miura M, Ohki H, Yoshiba S, et al. Adverse effects of methylprednisolone pulse therapy in refractory Kawasaki disease. Arch Dis Child 2005;90:1096-7. Abstract
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