Mild hyperkalemia and low eGFR a tedious recipe for cardiac disaster in the elderly: an unusual reversible cause of syncope and heart block

Abstract

Hyperkalemia affects the myocardial tissue producing electrocardiographic abnormalities, such as prolongation of the P-R interval, tall peaked T waves, a reduction in the amplitude and an increase in the duration of P wave, and atrial and ventricular arrhythmias, including variable degree heart blocks. Elderly patients are particularly predisposed to developing hyperkalemia and the associated abnormalities due to an age-related reduction in glomerular filtration rate and pre-existing medical problems. Therefore, the impact of aging on potassium homeostasis must be taken into consideration, and preventive measures, such as early recognition of possible hyperkalemia in the geriatric population treated with certain medications or supplements must be investigated. The threshold for cardiac arrhythmias in the elderly can be lower than the general population. We report 3 unusual cases of mild hyperkalemia in elderly patients presenting with hypotension, syncope and variable degree heart blocks which resolved spontaneously with the correction of hyperkalemia.

Clinical Significance of Incident Hypokalemia and Hyperkalemia in Treated Hypertensive Patients in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

“…Hyperkalemia, though infrequent, may present a more alarming cardiovascular risk, and deserves additional study. 20 What is clear, however, is that the cardioprotective actions of diuretic use are unaffected by consequent, but treatable, alterations in serum potassium.…”

BRASH syndrome

“…BRASH syndrome is an acronym for Bradycardia, Renal failure, AV node blocker, Shock, and Hyperkalaemia. The syndrome is characterised by a pentad of these clinical findings and is often under-recognised or confused with simple electrolyte abnormalities such as hyperkalaemia 3. There are several triggers for BRASH syndrome4: antihypertensives, acute kidney injury and dehydration are all potential causes.…”

Bradycardia, Renal Failure, Atrioventricular-nodal Blocker, Shock, and Hyperkalemia Syndrome Diagnosis and Literature Review

“…It was noticed that many clinicians have not clearly mentioned this clinical presentation as BRASH syndrome. Nine cases were identified in seven different studies [2][3][4][5][6][7][8]. The age of presentation ranged between 24 and 97 years with the mean age of 72 years.…”