Role of Medication Reconciliation in Managing Bradycardia: A Rare Cause of Medication-Induced Sinus Bradycardia

Sinus bradycardia is defined as a heart rate of less than 60 beats per minute (bpm), and it can be attributed to many etiologies, some of which are reversible, including but not limited to acute coronary syndrome, active infections, electrolyte imbalances, hypothyroidism, and medications. We report the case of a 64-year-old man who was admitted to the intensive care unit for the management of status epilepticus, where he developed new-onset, life-threatening sinus bradycardia, requiring placement on support with two inotropic agents (epinephrine and dopamine) due to persistent hemodynamic instability. Cardiology was consulted as a result, and after extensive workup, including review of past medical conditions, laboratory testing, and telemetry review, including that for reversible etiologies, we identified one of the antiepileptic agents on his medication list as the culprit of his sinus bradycardia. This case serves to contribute to existing, very limited, clinical data on its adverse cardiovascular effects.