A senior cardiologist from New York with more than three decades of clinical experience has issued a strong caution about the combined use of two widely prescribed heart medications, warning that the pairing may trigger a rare but potentially fatal condition known as BRASH syndrome. The warning is especially relevant for older adults and patients with underlying kidney concerns.
Dr Evan Levine of Mount Sinai Hospital recently highlighted this risk in a social media video, urging doctors to reassess treatment plans when beta blockers are prescribed alongside certain calcium channel blockers. According to Dr Levine, while both drugs are effective when used individually, their combined impact on the heart’s electrical system can become dangerous under specific circumstances.
BRASH syndrome refers to a cascade of medical complications including an abnormally slow heart rate kidney failure disruption of the heart’s AV node shock and elevated potassium levels. Beta blockers such as metoprolol atenolol and carvedilol and non-dihydropyridine calcium channel blockers like diltiazem and verapamil all reduce heart rate by acting on the AV node. When taken together their effects can intensify far beyond what is intended.
The risk increases significantly in elderly patients particularly during illness. Dr Levine explained that dehydration caused by infections such as colds or flu can impair kidney function. Once the kidneys struggle the body is unable to clear these medications effectively causing drug levels to rise rapidly. At the same time potassium levels may increase further slowing the heart rate and dropping blood pressure. This creates a dangerous cycle that can quickly spiral into a medical emergency.
Dr Levine stressed that the combination of slowed heart rhythm high potassium and falling blood pressure can worsen kidney failure even further making early recognition critical. He advised clinicians to consider safer alternatives where possible such as amlodipine or medications that do not affect the AV node in the same way.
Patients were also advised to remain alert to symptoms such as dizziness extreme fatigue fainting or feeling generally unwell. Anyone experiencing sudden illness while taking heart medications should seek urgent medical attention and clearly inform healthcare providers about all prescribed drugs.
This information is intended for awareness only and should not replace advice from a qualified healthcare professional.