3016 Can Primary Biliary Cirrhosis Cause Bradycardia?

Abstract

INTRODUCTION: Obstructive jaundice is a known cause of sinus bradycardia. It is usually attributed to the effect of bile salts on the electrophysiology of the heart and mainly on the SA node. But can Primary biliary cirrhosis cause bradycardia? Here, we are presenting a case of sinus bradycardia with a junctional rhythm that could be secondary to primary biliary cirrhosis. CASE DESCRIPTION/METHODS: A 65-year-old female with a history of primary biliary cirrhosis complicated by esophageal varices and recurrent ascites. The patient presented with a syncopal episode. The patient had a history of episodes of lightheadedness for several days before admission. Upon arrival at the hospital, the patient was bradycardiac with heart rate around 30 and she was hypotensive. She was given several doses of atropine and then she was started on dopamine drip. Initial EKG showed that the patient has a junctional rhythm. After reviewing the patient cardiac history, we found that the patient didn't have any heart issues before and she had a coronary angiogram done one year ago and showed normal coronaries. Medications were reviewed and showed that the patient was on Metoprolol 25 mg twice daily for anxiety and she was on it for more than 10 years and there were no recent changes in the dose. Labs showed that the patient had mild elevation is AST 41 IU/L and ALT 62 IU/L. Total serum bilirubin was 1.7 mg/dl (mildly elevated) and direct bilirubin was 0.7 mg/dl (mildly elevated). After beta-blocker was held, the patient heart rate improved, and dopamine drip was discontinued. DISCUSSION: This is a case of primary biliary cirrhosis who presented with symptomatic bradycardia. This patient was on beta-blockers for a long period of time and she didn't have any heart issues given her last coronary angiogram and echocardiogram were normal. We believe that one of the contributors of the patient bradycardia is the primary biliary cirrhosis itself as it can cause bradycardia which is believed to be secondary to bile salts. In conclusion, primary biliary cirrhosis should be considered as a cause of bradycardia and the use of metoprolol in those patients should be closely monitored as Metoprolol is primarily metabolized by the liver and can intensify the bradycardia.