Case report: severe bradycardia, a reversible cause of “Cardio-Renal-Cerebral Syndrome”

English version České info

Background:
Cardio-Renal Syndromes were first classified in 2008 and divided into five subtypes. The type 1 Cardio-Renal Syndrome (CRS) is characterized by acute decompensation of heart failure leading to acute kidney injury (AKI). Bradyarrhythmia was not mentioned in the classification as a cause for low cardiac output (CO) in type 1 CRS. Besides, CRS was not previously associated with central nervous system (CNS) injury despite the fact that cardiac, renal and neurological diseases can coexist.

Case presentation:
We report the case of a 93-year old diabetic man who presented for obnubilation. He had a slow atrial fibrillation, was not hypotensive and was not taking any beta-blocker. He developed, simultaneously, during his hospitalization, severe bradycardia (<35 beats per minute), oligoanuria and further neurological deterioration without profound hypotension. An ECG revealed a complete atrioventricular (AV) block and all his symptoms were completely reversed after pacemaker insertion. His creatinine decreased progressively afterwards and at discharge, he was conscious, alert and well oriented.

Conclusion:
Our case highlights the importance of an early recognition of low cardiac output secondary to severe bradyarrhythmia and its concurrent repercussion on the kidney and the brain. This association of the CRS with CNS injury-that we called “Cardio-Renal-Cerebral Syndrome”–was successfully treated with permanent pacemaker implantation.

Keywords:
Cardio-Renal Syndrome, Acute kidney injury, Low cardiac output, Bradyarrhythmia, Neurological deterioration, Pacemaker, Case report

Autoři: Mabel Aoun ^1*; Randa Tabbah ²
Působiště autorů: Nephrology Department of Saint-Georges Hospital Ajaltoun and Saint-Joseph University, Beirut, Lebanon. ¹; Holy Spirit University of Kaslik, Jounieh, Lebanon. ²
Vyšlo v časopise: BMC Nefrol 2016, 17:162
Kategorie: Case report
prolekare.web.journal.doi_sk: https://doi.org/10.1186/s12882-016-0375-7

© 2016 The Author(s).

Open access
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: http://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-016-0375-7

Souhrn

Keywords:
Cardio-Renal Syndrome, Acute kidney injury, Low cardiac output, Bradyarrhythmia, Neurological deterioration, Pacemaker, Case report

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