Dose-dependent bradycardia as a rare side effect of corticosteroids: a case report and review of the literature

Bodakçı, Erdal; Korkmaz, Cengiz

doi:10.1007/s00296-018-4167-1

Cited by 18 publications

(14 citation statements)

References 27 publications

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“…This has been documented in oncological patients for whom steroids are used for nausea and vomiting, in patients with severe Kawasaki disease treated in part with prednisolone and in other populations. [23][24][25] Proposed mechanisms for steroid-induced dysrhythmia are several. With their intrinsic mineralocorticoid activity causing retention of sodium, hypertension can ensue, which may prompt baroreceptor-mediated reflex bradycardia.…”

Section: Discussionmentioning

confidence: 99%

Sinus bradycardia in a toddler with multisystem inflammatory syndrome in children (MIS-C) related to COVID-19

et al. 2021

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This report documents a case of sinus bradycardia in a hospitalised 27-month-old girl with a history of moderate persistent asthma, recent suspected viral respiratory infection and suspicion for multisystem inflammatory syndrome in children (MIS-C). This patient developed profound sinus bradycardia during her hospitalisation despite an overall well clinical appearance and good outcome. Reports of bradycardia related to COVID-19 infection are few but growing in number. In this article, we discuss what has been observed in the literature about bradycardia in relation to COVID-19 and MIS-C. We also propose sinus bradycardia as a potential sign of MIS-C with recent respiratory symptoms, which would warrant close follow-up of such patients.

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Section: Discussionmentioning

confidence: 99%

Sinus bradycardia in a toddler with multisystem inflammatory syndrome in children (MIS-C) related to COVID-19

et al. 2021

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“…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 ]. Wide variety of arrhythmias including ventricular ectopic, ventricular tachycardias and sinus tachycardia, and bradycardias [ 1 - 2 ] are identified, in a prospective trial done by Jain et al [ 1 ]; 33% of patient have been noted to develop sinus bradycardia.…”

Section: Discussionmentioning

confidence: 99%

“…Several hypotheses for steroid-induced bradycardia have been suggested, however, the exact mechanism by which this occurs is currently unknown [ 6 ]. Steroids may exert a bradycardic effect through suppression of cytokine production and function of the sympathetic nervous system [ 3 ]. This could be the possible mechanism of bradycardia in our case.…”

Section: Discussionmentioning

confidence: 99%

“…Steroids are one of the most commonly used drugs in hospital and outpatient setting for a wide variety of pathologies ranging from chronic obstructive pulmonary disease (COPD)/asthma exacerbation to autoimmune diseases and inflammatory conditions. Common complications associated with steroids including hyperglycemia, electrolyte abnormalities, hypertension, delirium, and behavioral changes in elderly patients; serious adverse events including cardiac arrhythmias have been reported in the literature [1][2][3]. Over the years, few case reports have been published about the associated sinus bradycardia with pulse dose corticosteroids administration both IV and oral [1][2]4].…”

Section: Introductionmentioning

confidence: 99%

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Steroid-Induced Sinus Bradycardia

Khandelwal¹,

Madathala²,

Chennaiahgari

et al. 2021

Cureus

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Steroids are one of the most commonly used drugs and known to be associated with several side effects. There have been case reports about the associated sinus bradycardia with pulse dose corticosteroids administration both IV and oral. We present a case of asymptomatic sinus bradycardia associated with oral prednisone 40 mg. A 69-year-old male was admitted to the ICU for sepsis and subsequently was found to have gastrointestinal (GI) bleed. He developed an acute gout attack during hospitalization and was treated with prednisone 40 mg. Over the next 24 hours, the patient's heart rate dropped to 30s to 40s beats/minute while other vitals have remained stable. He was monitored on telemetry and review of the rhythm strips, as well as a 12-lead electrocardiogram (EKG), that showed sinus bradycardia; no pauses or atrio-ventricular (AV) nodal blocks were identified. The patient was not on any beta blocker or other therapies commonly associated with sinus bradycardia. His steroids were stopped while all other medications were continued. His heart rate slowly started to improve over the next 24 hours. He was not found to have any further episodes of bradycardia. Our case is unusual as we noted transient asymptomatic bradycardia with oral prednisone 40 mg dose. While bradycardia is reversible and may go unnoticed, it is important for the clinician to be aware of this adverse effect and include it in the list of potential differentials for bradycardia.

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“…Other studies have suggested reflex bradycardia by activation of low-pressure baroreceptors or possible long QT syndrome gene mutations as possible mechanisms[ 4 ]. According to a recent literature review[ 7 ], corticosteroid-induced bradycardia seems to occur even with oral steroid administration, and a dose-dependent risk has also been reported[ 18 ]. In this patient, the HR decreased as corticosteroid was administered, and the baseline HR recovered after corticosteroid discontinuation.…”

Section: Discussionmentioning

confidence: 99%

Corticosteroid-induced bradycardia in multiple sclerosis and maturity-onset diabetes of the young due to hepatocyte nuclear factor 4-alpha mutation: A case report

Sohn¹,

Kim²,

Joo³

2022

WJCC

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BACKGROUND Intravenous steroid pulse therapy is the treatment of choice for acute exacerbation of multiple sclerosis (MS). Although steroid administration is generally well-tolerated, cases of cardiac arrhythmia have been reported. Herein, we describe a young woman who developed marked sinus bradycardia and T-wave abnormalities after corticosteroid administration. We also present plausible explanations for the abnormalities observed in this patient. CASE SUMMARY An 18-year-old woman experienced vertiginous dizziness and binocular diplopia 1 wk prior to admission. Neurological examination revealed left internuclear ophthalmoplegia with left peripheral-type facial palsy. The initial laboratory results were consistent with those of type 2 diabetes. Brain magnetic resonance imaging revealed multifocal, non-enhancing, symptomatic lesions and multiple enhancing lesions. She was diagnosed with MS and maturity-onset diabetes of the young. Intravenous methylprednisolone was administered. On day 5 after methylprednisolone infusion, marked bradycardia with T-wave abnormalities were observed. Genetic evaluation to elucidate the underlying conditions revealed a hepatocyte nuclear factor 4-alpha (HNF4A) gene mutation. Steroid treatment was discontinued under suspicion of corticosteroid-induced bradycardia. Her electrocardiogram changes returned to normal without complications two days after steroid discontinuation. CONCLUSION Corticosteroid-induced bradycardia may have a significant clinical impact, especially in patients with comorbidities, such as HNF4A mutations.

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Dose-dependent bradycardia as a rare side effect of corticosteroids: a case report and review of the literature

Cited by 18 publications

References 27 publications

Sinus bradycardia in a toddler with multisystem inflammatory syndrome in children (MIS-C) related to COVID-19

Sinus bradycardia in a toddler with multisystem inflammatory syndrome in children (MIS-C) related to COVID-19

Steroid-Induced Sinus Bradycardia

Corticosteroid-induced bradycardia in multiple sclerosis and maturity-onset diabetes of the young due to hepatocyte nuclear factor 4-alpha mutation: A case report

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