[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-458300-105":59,"doc-detail-458300-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","unmasking-brash-syndrome-a-clinical-challenge-in-bradycardia-and-renal-dysfunction","Unmasking BRASH Syndrome - A Clinical Challenge in Bradycardia and Renal Dysfunction","","BRASH syndrome describes a clinical constellation of bradycardia, renal dysfunction, exposure to atrioventricular (AV) nodal-blocking medications, shock, and hyperkalemia. Although the condition is fully reversible and can explain symptomatic bradycardia, it is often missed. Prompt recognition matters when bradycardia coexists with impaired kidney function and elevated serum potassium, especially with recent or ongoing AV nodal blockers. Management requires simultaneous correction of each contributing factor rather than isolated treatment of a single abnormality.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/unmasking-brash-syndrome-a-clinical-challenge-in-bradycardia-and-renal-dysfunction/458300/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/unmasking-brash-syndrome-a-clinical-challenge-in-bradycardia-and-renal-dysfunction/458300.png","ImageObject",300,407,{"name":92,"@type":93},"Damian","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-08","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":24},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What clinical features define BRASH syndrome?","Question",{"text":112,"@type":113},"BRASH is characterized by bradycardia, renal dysfunction, exposure to AV nodal-blocking drugs, shock, and hyperkalemia.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"When should clinicians suspect BRASH syndrome?",{"text":117,"@type":113},"BRASH should be suspected when bradycardia occurs in the setting of impaired kidney function and elevated serum potassium, particularly with recent or ongoing AV nodal-blocking agent use.",{"name":119,"@type":110,"acceptedAnswer":120},"How is BRASH syndrome managed to avoid unnecessary procedures?",{"text":121,"@type":113},"Effective management requires addressing all contributing factors together, including simultaneous correction of hyperkalemia and effects of AV nodal-blocking medications, rather than treating a single abnormality alone.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},458300,1790752518,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":24,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":52,"preview_page_count":4},137451208677,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Review began 11/25/2025  \nReview ended 12/04/2025  \nPublished 12/08/2025  \n© Copyright 2025  \nZuhri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98773  \nOpen Access Case Report  \nUnmasking BRASH Syndrome: A Clinical  \nChallenge in Bradycardia and Renal Dysfunction  \nErvan Zuhri 1, Sabrina Erriyanti 2  \n1. Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Jakarta, IDN 2. Cardiology and Vascular Medicine, PT Pelayaran Nasional Indonesia (PELNI) Hospital, Jakarta, IDN  \nCorresponding author: Ervan Zuhri, [ervanzuhri@gmail.com](ervanzuhri@gmail.com)  \nAbstract  \nThe term BRASH refers to a clinical constellation characterized by bradycardia, renal dysfunction, atrioventricular (AV) nodal-blocking medication exposure, shock, and hyperkalemia. Although the condition represents a fully reversible cause of symptomatic bradycardia, it frequently goes unrecognized. Prompt identification and a clear understanding of its underlying mechanisms are essential to avoid unnecessary procedures. The syndrome should be suspected when a patient presents with bradycardia in the setting of impaired kidney function and elevated serum potassium, particularly when there is recent or ongoing use of AV nodal-blocking agents. Early recognition is critical because effective management requires addressing each contributing factor simultaneously, rather than treating a single abnormality in isolation.  \nCategories: Cardiology, Emergency Medicine, Internal Medicine  \nKeywords: bradycardia, brash, hyperkalemia, renal dysfunction, sinus node dysfunction  \nIntroduction  \nBRASH syndrome represents a clinical pattern in which marked bradycardia occurs simultaneously with impaired renal function, exposure to atrioventricular (AV) nodal-blocking medications, circulatory instability, and elevated potassium levels. The syndrome develops through the combined effects of hyperkalemia and drugs that slow AV nodal conduction, most commonly beta-blockers or nondihydropyridine calcium channel blockers. Its presentation is highly variable, ranging from mild reductionsin heart rate to profound hemodynamic collapse [1] . Although the condition is fully reversible, it is frequently overlooked in real-world practice, as its individual components are often misattributed to isolated hyperkalemia, medication toxicity, or renal dysfunction rather than recognized as a single unifying syndrome. Recognizing the mechanism behind this syndrome at an early stage is essential to avoid unnecessary procedures, including pacemaker implantation [2] .  \nCase Presentation  \nA 65-year-old woman with a background of coronary artery disease without significant stenosis, grade 2 diastolic dysfunction with preserved systolic function, hypertension, and stage 5 chronic kidney disease (not yet requiring dialysis) arrived at the emergency department complaining of profound fatigue and atypical chest discomfort. Her chronic medications consisted of clonidine 0.15 mg twice daily, nitroglycerin 2.5 mg twice daily, candesartan 16 mg daily, acetylsalicylic acid 100 mg daily, and simvastatin 40 mg daily. In an attempt to control persistently elevated blood pressure, she began taking diltiazem 100 mg daily on her own two days before presentation.  \nOn arrival, she was conscious but markedly bradycardic, with a heart rate of 36 beats per minute and a blood pressure of 89/52 mmHg. Examination showed generalized weakness, a slow pulse, and cool extremities. Laboratory studies revealed severe hyperkalemia, worsening renal function, metabolic acidosis, and anemia (Table 1) . Her initial ECG demonstrated a sinus pause with junctional escape rhythm at 36 beats per minute, without the classic ECG abnormalities typically associated with hyperkalemia (Figure 1) .","cbCaiuLT1gPSiCi0","https://ap.wps.com/l/cbCaiuLT1gPSiCi0","pdf",1129369,"English","# Abstract\n# Introduction\n# Case Presentation\n## Laboratory and ECG Findings\n## Treatment and Clinical Course\n# How to Cite","[{\"question\":\"What clinical features define BRASH syndrome?\",\"answer\":\"BRASH is characterized by bradycardia, renal dysfunction, exposure to AV nodal-blocking drugs, shock, and hyperkalemia.\"},{\"question\":\"When should clinicians suspect BRASH syndrome?\",\"answer\":\"BRASH should be suspected when bradycardia occurs in the setting of impaired kidney function and elevated serum potassium, particularly with recent or ongoing AV nodal-blocking agent use.\"},{\"question\":\"How is BRASH syndrome managed to avoid unnecessary procedures?\",\"answer\":\"Effective management requires addressing all contributing factors together, including simultaneous correction of hyperkalemia and effects of AV nodal-blocking medications, rather than treating a single abnormality alone.\"}]","Unmasking BRASH Syndrome - A Clinical Challenge in Bradycardia and Renal Dysfunction | PDF"]