BRASH syndrome in acute coronavirus disease 2019 myocarditis and acute kidney injury: The importance of early recognition of an iatrogenic spiral
Year: 2026
Type: article
Abstract: BRASH syndrome (Bradycardia, Renal failure, AV-nodal blockade, Shock, and Hyperkalemia) represents a distinctive but frequently overlooked iatrogenic complication occurring when negative chronotropic agents—predominantly beta-blockers or non-dihydropyridine calcium channel blockers—accumulate to toxic concentrations in patients with renal impairment.1 The syndrome comprises five key features: bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalaemia. Although described in the critical care literature, BRASH remains substantially underrecognised in routine clinical practice, with findings frequently misattributed to primary myocardial disease, sepsis, or decompensated heart failure.
Source: HeartRhythm Case Reports
Authors: Adrija Mehta, Sai Allu, Nassim Krim
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,100
OpenAlex ID: W7202282478