# Symptomatic sinus bradycardia during the recovery phase of high-altitude pulmonary edema: a case report

## TL;DR

A healthy man developed severe slow heart rate after recovering from high-altitude pulmonary edema, likely due to a rebound in vagal tone and steroid withdrawal.

## Contribution

Highlights a novel clinical observation linking HAPE recovery with symptomatic sinus bradycardia due to vagal rebound and steroid withdrawal.

## Key findings

- Symptomatic sinus bradycardia occurred during HAPE recovery with heart rate as low as 37 bpm.
- Intravenous potassium and fluid resuscitation resolved the bradycardia, restoring heart rate to 59 bpm.
- Rebound vagal tone and steroid withdrawal are suggested as contributing factors to the bradycardia.

## Abstract

This case report describes a 28-year-old healthy male who developed high-altitude pulmonary edema (HAPE) after a rapid ascent. While his condition improved with standard therapy (including corticosteroids, diuretics, and supplemental oxygen), he developed symptomatic sinus bradycardia (heart rate nadir: 37 bpm) 2 days after discontinuation of these medications. The bradycardia resolved with intravenous potassium supplementation and fluid resuscitation, and his heart rate recovered to 59 bpm. This case highlights that a rebound in vagal tone and steroid withdrawal may contribute to severe bradycardia during the HAPE recovery phase, warranting heightened clinical vigilance.