Profound bradycardia and hypotension in a normal heart

Abstract

Bradycardia is a common arrhythmia that rarely can be caused by autonomic dysfunction. There are case reports of bradycardia attributed to diabetic autonomic neuropathy, 1 Horng H.C. Chen F.C. Kuo C.P. Wu C.T. Wong C.S. Bradycardia and hypotension refractory to ephedrine and atropine treatment: severe autonomic dysfunction with abnormal heart rate variability. Acta Anaesthesiologica Taiwanica. 2006; 44: 109-112 PubMed Google Scholar and Guillain-Barré syndrome. 2 Pfeiffer G. Schiller B. Kruse J. Netzer J. Indicators of dysautonomia in severe Guillain-Barre syndrome. J Neurol. 1999; 246: 1015-1022 Crossref PubMed Scopus (47) Google Scholar Autoimmune autonomic neuropathy (AAN), also known as idiopathic autonomic neuropathy or pure pandysautonomia, 3 Schondorf R. Low P.A. Idiopathic orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia?. Neurology. 1994; 43: 132-137 Crossref Google Scholar has been reported to rarely manifest with bradycardia as one of a constellation of signs. 4 Suarez G.A. Fealey R.D. Cailleri M. Low P.A. Idiopathic autonomic neuropathy: Clinical, neurophysiologic, and follow-up on 27 patients. Neurology. 1994; 44: 1675-1682 Crossref PubMed Google Scholar , 5 Klein C.M. Vernino S. Lennon V.A. et al. The spectrum of autoimmune autonomic neuropathies. Ann Neurol. 2003; 53: 752-758 Crossref PubMed Scopus (177) Google Scholar We present an unusual case of severe bradycardia in a young patient with probable autoimmune autonomic dysfunction.