J Clinical Cardiology and Cardiovascular Intervention Copy rights@ Han Naung Tun, Auctores Publishing – Volume 3(5)-067 www.auctoresonline.org ISSN:2641-0419 Page 1 of 5 Extreme Bradycardia with Variable Block in Severe Hyperkalemia: A Forgotten Culprit in Brady-arrhythmia Han Naung Tun 1,2,* , Syed Haseeb Raza 3 1 Coronary Care Unit, Heart and Vascular Centre, Victoria Hospital, Yangon, Myanmar 2 National Representative of Heart Failure Specialist of Tomorrow (HoT) for Myanmar in European Heart Failure Association and Clinical & Research Working Group of Cardiac Cellular Electrophysiology, European Society of Cardiology, Sophia Antipolis, France 3 Department of Cardiac Electrophysiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan *Corresponding author: Han Naung Tun, Coronary Care Unit, Heart and Vascular Centre, Victoria Hospital, Yangon, Myanmar. Received date: May 01, 2020; Accepted date: May 21, 2020; Published date: May 28, 2020 Citation: Han Naung. Tun., Syed Haseeb. Raza., (2020) Extreme Bradycardia with Variable Block in Severe Hyperkalemia: A Forgotten Culprit in Brady-arrhythmia. J,Clinical Cardiology and Cardiovascular Interventions, 3(6); Doi:10.31579/2641-0419/067 Copyright: © 2020 Han Naung Tun, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Bradycardia is commonly encountered in emergency department. Hyperkalemia may sometime cause bradycardia with block and also synergize with AV node blockers to cause bradycardia and hypoperfusion. We report a 53 years old male with history of hypertension, congestive heart failure and coronary artery disease was admitted to hospital for sudden onset of breathlessness. He underwent percutaneous coronary intervention (PCI) to left anterior descending (LAD) artery and left circumflex (LCx) artery one year ago and taking Aspilet 80 mg for daily, Clopidogrel 75 mg daily, Ramipril 5 mg daily, Atorvastatin 20 mg daily, Metoprolol 25 mg daily, Spironolactone 25 mg daily and Frusemide 40 mg daily. Significant physical examination was remarkable for a temperature 97.5’F, blood pressure of 110/70 mmHg, heart rate of 40 beats per minute, oxygen saturation was 99% on air and both lung were full with audible crepitation by auscultation. He was given atropine 0.6 mg bolus and transcutanaeous pacing with unimproved heart rate and then a transvenous pacing was immediately placed before the blood investigation results were returned. His relevant laboratory values were significant for a potassium of 7.99 mmol/L( ref range : 3.5-5.2 mmo/l) , creatinine of 458 micmol/L ( ref range : 59-104 micmol/L) , Urea of 33.9 mmol/L ( ref range : 2.7 – 8.0 mmol/l), random blood glucose of 233mg/dl , sodium 126.8 mmol/L ( ref range 135-145 mmol/L ) , anion gap of 13.5 mmol/? (ref range : 3.6 -11.0 mmo/L) and bicarbonate of 15.6 mmil/L ( ref range: 22-29 mmol/L). He was given calcium glucoronate , insulin with dextrose , kaexylate , nebulizer salbutamol with significant improvement in his potassium levels to 4.6 in 24 hours . In Cardiac intensive care unit his heart rate was improved and the transvenous pacemaker was turned off the next day. Keywords: hyperkalemia; bradycardia; pacemaker; heart block Background Bradycardia is commonly encountered in emergency department. Hyperkalemia may cause bradycardia with block and may also synergize with AV node blockers to cause bradycardia and hypoperfusion.1 Potassium is vital for regulating the normal electrical activity of the heart. Increased extracellular potassium reduces myocardial excitability, with depression of both pacemaking and conducting tissues.2 Progressively worsening hyperkalaemia leads to suppression of impulse generation by the SA node and reduced conduction by the AV node and His-Purkinje system, resulting in bradycardia and conduction blocks and ultimately cardiac arrest.3 Case Fifty three year-old man known to have coronary heart disease, congestive heart failure, type 2 diabetes mellitus and hypertension was taking Aspilet 80 mg for daily, Clopidogrel 75 mg daily, Ramipril 5 mg daily, Atorvastatin 20 mg daily, Metoprolol 25 mg daily, Spironolactone 25 mg daily and Frusemide 40 mg daily. He underwent percutaneous coronary intervention (PCI) to left anterior descending (LAD) artery and left circumflex (LCx) artery one year ago. He presented to the emergency department in acute shortness of. He had no documented fever, no history of trauma, no gastroenterological symptoms and no other recent complaints before this event but his family members said that he had muscle pain before 3 days and had intramuscular injection of pain killer. On arrival to the emergency department, he was dyspnoic with lightheadedness. Her initial vital signs showed a temperature of 97.5’F, blood pressure of 110/70 mmHg, heart rate of 40 beats per minute, oxygen saturation was 99% on air and both lung were audibled crepitation by auscultation. His glucose level, determined by a finger stick, was 233mg/dl. The patient was given IV atropine 0.6 mg bolus, started on intravenous frusemide 80 Open Access Case Report Journal of Clinical Cardiology and Cardiovascular Interventions Han Naung Tun AUCTORES Globalize your Research