Clinical Mysteries • Metabolic Medicine
The Bradycardia That Wasn’t a Heart Problem
The presentation
Profound bradycardia and weakness looked like primary conduction disease until the chemistry returned.
The first explanation was plausible, but the pattern did not fully fit. A deliberate second look focused on physiology, medication/exposure history, serial observations and the clue that the initial diagnosis could not explain.
The turn
ECG progression plus renal dysfunction pointed to potassium toxicity.
Diagnosis
Severe hyperkalaemia
Why this case matters
Electrolytes can imitate primary cardiac disease.
Take-home message: When the clinical course contradicts the working diagnosis, stop escalating the same treatment and rebuild the problem from first principles.