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Acute symptomatic sinus bradycardia in a woman treated with pulse dose steroids for multiple sclerosis: a case report

Overview of attention for article published in Journal of Medical Case Reports, September 2015
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Title
Acute symptomatic sinus bradycardia in a woman treated with pulse dose steroids for multiple sclerosis: a case report
Published in
Journal of Medical Case Reports, September 2015
DOI 10.1186/s13256-015-0701-x
Pubmed ID
Authors

Amartya Kundu, Timothy P. Fitzgibbons

Abstract

Sinus bradycardia has been reported after administration of pulse dose steroids, although most cases have occurred in children and are asymptomatic. We report a case of acute symptomatic sinus bradycardia due to pulse dose steroids in a woman with multiple sclerosis. Interestingly, this patient also suffered from inappropriate sinus tachycardia due to autonomic involvement of multiple sclerosis. A 48-year-old Caucasian woman with multiple sclerosis and chronic palpitations due to inappropriate sinus tachycardia was prescribed a 5-day course of intravenous methylprednisolone for treatment of an acute flare. Immediately following the fourth dose of intravenous methylprednisolone, she developed dyspnea, chest heaviness, and lightheadedness. She was referred to the emergency department where an electrocardiogram showed marked sinus bradycardia (40 beats per minute). Initial laboratory test results, including a complete blood count, basic metabolic profile and cardiac biomarkers, were normal. She was admitted for observation on telemetry monitoring. Her heart rate gradually increased and her symptoms resolved. Her outpatient dose of atenolol, taken for symptomatic inappropriate sinus tachycardia, was resumed. Our patient's acute symptoms were attributed to symptomatic sinus bradycardia due to pulse dose steroid treatment. Although several theories have been suggested to explain this phenomenon, the exact mechanism still remains unknown. It does not warrant any specific treatment, as it is a self-limiting side effect that resolves after discontinuing steroid infusion. Young patients who are free of any active cardiac conditions can safely be administered pulse dose steroids without monitoring. However, older patients with active cardiac conditions should have heart rate and blood pressure monitoring during infusion. Our patient also suffered from inappropriate sinus tachycardia, a manifestation of autonomic involvement of multiple sclerosis that has not been previously described. This case has implications for the pathogenesis and treatment of dysautonomia in patients with multiple sclerosis.

Twitter Demographics

The data shown below were collected from the profile of 1 tweeter who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 18 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 18 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 4 22%
Unspecified 4 22%
Other 3 17%
Student > Postgraduate 2 11%
Student > Ph. D. Student 2 11%
Other 3 17%
Readers by discipline Count As %
Medicine and Dentistry 11 61%
Unspecified 4 22%
Mathematics 1 6%
Neuroscience 1 6%
Social Sciences 1 6%
Other 0 0%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 25 September 2015.
All research outputs
#5,452,697
of 6,401,542 outputs
Outputs from Journal of Medical Case Reports
#940
of 1,160 outputs
Outputs of similar age
#160,486
of 201,079 outputs
Outputs of similar age from Journal of Medical Case Reports
#43
of 59 outputs
Altmetric has tracked 6,401,542 research outputs across all sources so far. This one is in the 1st percentile – i.e., 1% of other outputs scored the same or lower than it.
So far Altmetric has tracked 1,160 research outputs from this source. They receive a mean Attention Score of 3.1. This one is in the 1st percentile – i.e., 1% of its peers scored the same or lower than it.
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We're also able to compare this research output to 59 others from the same source and published within six weeks on either side of this one. This one is in the 1st percentile – i.e., 1% of its contemporaries scored the same or lower than it.