Bradycardia Associated with Steroid Use for Laryngeal Edema in an Adult: A Case Report and Literature Review

Abstract

Steroids are used for specific indications in the perioperative period to reduce laryngeal or spinal cord edema, or for prophylaxis and treatment of postoperative nausea and vomiting. Given the other potential causes for hemodynamic alterations in the perioperative setting, it is important for physicians to be aware of cardiovascular side effects of short term steroids. Changes in blood pressure and heart rate, cardiac dysrhythmias, and even death have been described in patients receiving short term intravenous steroids. Bradycardia has been reported following short term methylprednisolone and dexamethasone therapy in both adult and pediatric patients. There are only two case reports in the literature of bradycardia following short term intravenous dexamethasone use in adult patients. This is the first case report that describes bradycardia following the use of dexamethasone in the postoperative setting for management of laryngeal edema in an adult. Telemetry and twelve lead electrocardiograms revealed sinus bradycardia and correlated directly with administration of dexamethasone in our patient. Bradycardia resolved following discontinuation of dexamethasone. We advocate for hemodynamic monitoring in patients receiving more than one dose of intravenous steroid therapy in the perioperative period, especially those with known cardiac and hepatic comorbidities and those taking medications with negative chronotropic effects.

Steroid-Induced Sinus Bradycardia

“…In most of the case reports, the patient either received IV dexamethasone [4,6] or IV methylprednisolone [4][5]7] or high dose oral prednisolone [8]. There is one study where sinus bradycardia was documented after oral methylprednisolone dose of 52 mg as well as with tapering dose of prednisone [3].…”

“…There are few case reports over the years about the association of pulse dose corticosteroid therapy and cardiac arrhythmias especially sinus bradycardia [ 1 - 2 , 5 ]. In most of the case reports, the patient either received IV dexamethasone [ 4 , 6 ] or IV methylprednisolone [ 4 - 5 , 7 ] or high dose oral prednisolone [ 8 ]. There is one study where sinus bradycardia was documented after oral methylprednisolone dose of 52 mg as well as with tapering dose of prednisone [ 3 ].…”

Acute Symptomatic Sinus Bradycardia in High-Dose Methylprednisolone Therapy in a Woman With Inflammatory Myelitis: A Case Report and Review of the Literature

“…11,15,17,18 In a review of the literature by Stroeder et al, 19 93 cases of bradycardia attributed to PST have been reported, from 1970 to 2014. Other cases, not included in this work, have been reported 12-14,17,18 reaching a total amount of 105 cases of bradycardia consequently to corticosteroids administration (11 case reports, 6 case series, 2 prospective studies, and 1 retrospective study).…”

Sinus Bradycardia Rare but Expected Complications of Chemo Regimen Involving Dexamethasone: Case Report

“…It has also been described following short term oral prednisone use. Cardiac arrhythmias as a result of dexamethasone use have been less frequently described and primarily involve pediatric patients [4].…”

“…Chemotherapy was planned with Bortezomib along with VAD regimen. Bortezomib: 2 mg (day 1,4,8,11), Vincristine: 0.5 mg (day 1 to day 4), Dexamethasone: 30 mg (day 1 to day 4), Doxorubicin: 10 mg (day 1 to day 4). The patient had uneventful three cycles of chemotherapy.…”