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A 67 year old woman with renal failure and sinus bradycardia¹

Q1: What are the possible causes of renal failure?
The most likely cause of the renal failure was introduction of the ACE inhibitor for treatment of hypertension. It is possible that this patient could have small vessel atheromatous renovascular disease or even bilateral renal artery stenosis. The renal failure could also be due to diabetes or hypertension, although the speed of progression makes the natural history of either disease unlikely.

Q2: What was the likely cause for the sinus bradycardia?
In this case, the sinus bradycardia was due to the effect of the increased dose of atenolol, the elimination of which was prolonged by the renal failure, therefore making the drug more potent. Other causes of sinus bradycardia are other drugs (for example, digoxin, verapamil), myocardial infarction, hypothyroidism, hypothermia or, more commonly, age related degeneration of the conduction system (sinoatrial disease). Symptomatic bradycardia associated with syncope or pre-syncopal episodes requires insertion of a temporary pacing wire and a permanent pacemaker may need to be considered.

Q3: Why did the temporary pacemaker fail to capture?
The most likely explanation . . . [Full text of this article]

Relevant Article

A 67 year old woman with renal failure and sinus bradycardia

S G Williams, M Bird, and P Currie
Postgrad. Med. J. 2004 80: 46. [Extract] [Full Text] [PDF]