# Unexpected Presentations of Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalemia (BRASH) Syndrome: A Report of Two Cases

## TL;DR

This paper describes two cases of a rare syndrome where kidney failure and certain medications cause dangerous heart rhythm issues, showing that simple medical treatment can lead to good outcomes.

## Contribution

The paper presents two new clinical cases of BRASH syndrome and highlights the effectiveness of non-invasive medical management.

## Key findings

- Early recognition of BRASH syndrome can prevent severe complications.
- Simple medical management was sufficient for favorable outcomes in both cases.
- The syndrome results from a synergistic effect of renal injury and atrioventricular nodal-blocking agents.

## Abstract

Bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia syndrome is an underrecognized phenomenon in which renal injury leads to hyperkalemia and inadequate clearance of atrioventricular nodal-blocking agents. The compounding effect of both insults can lead to a bradyarrhythmia that, in severe cases, can rapidly progress to cardiogenic shock. The degree of resulting pathology is usually out of proportion to either insulting agent given that there is a synergistic effect. Treatment strategies for this condition are not entirely clear, but it appears as if these patients often do not warrant aggressive interventions and can be managed medically. We report two cases with early recognition and simple medical management with resulting favorable outcomes.