Steroid-Induced Sinus Bradycardia

Abstract

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.

Hydrocortisone-induced symptomatic sinus bradycardia

“…A literature review revealed that steroid-induced bradycardia is likely underdiagnosed because most patients are asymptomatic,2 7 8 in contrast to our case where the patient experienced symptoms. Although the bradycardia resolves spontaneously after discontinuation of the medication, it is also crucial to rule out other, more prevalent causes of bradycardia, such as hypothyroidism, electrolyte imbalance and the use of drugs including beta-blockers, calcium channel blockers and digitalis.…”

“…Although steroid therapy’s more common side effects are hyperglycaemia, electrolyte abnormalities, hypertension, osteoporosis and gastritis, physicians need to be aware of the cardiovascular side effects of short-term steroids. Researchers have described changes in blood pressure, heart rate, cardiac dysrhythmias and even death in patients receiving short-term intravenous steroids 2 3…”

Bradycardia after pulse methylprednisolone therapy in a child—Uncommon side effect of a frequently used drug: A case report

“…It is usually benign in nature and asymptomatic. [ 8 ] Our patient was also clinically and hemodynamically stable. Common symptoms of bradycardia include dizziness, chest pain, fatigability, and syncope.…”

The inciting factor for bradycardia in COVID-19 patients: a potential harm of steroid treatment

“…COVID-19-induced bradyarrhythmia was reported ( 7 , 8 ), in addition to it, the many nonspecific bradycardia cases in patients without cardiovascular risk factors was also observed. Several reports have suggested that medications for COVID-19, such as remdesivir ( 9 - 14 ) or steroids ( 15 ), may be associated with the incidence of bradycardia; whereas bradycardia may also be linked to the SARS-CoV-2 infection itself, as previously reported in cases of influenza infection ( 16 ). To further understand the pathophysiology behind bradycardia in COVID-19, we evaluated whether the incidence rate of bradycardia in patients with COVID-19 was higher than that in patients with influenza and COVID-19.…”