Abstract Introduction Managing decompensated cirrhosis is particularly challenging due to complications such as portal hypertension, variceal bleeding, and coagulopathy. Octreotide, commonly used to manage variceal hemorrhage, is generally considered safe; however, rare cases of conduction abnormalities have been reported. We present a case of cardiac arrest with return of spontaneous circulation (ROSC) and persistent sinus bradycardia (SB) following octreotide initiation in a patient with decompensated cirrhosis. Case Presentation A 46-year-old man with decompensated cirrhosis, portal hypertension, and prior variceal band ligation presented with acute respiratory failure, septic shock, and hepatic encephalopathy. He was admitted to the ICU requiring mechanical ventilation and vasopressor support. Multiple episodes of melena necessitating transfusions complicated the hospital course. Due to concern for variceal bleeding, octreotide was initiated. Shortly thereafter injecting the bolus dose, he was bradycardic (HR-36) and had a cardiac arrest due to pulseless electrical activity. ROSC was achieved, and octreotide was discontinued. Unfortunately, the patient progressed to multi-organ failure, and after goals-of-care discussions, the family elected for comfort care measures. Discussion This case highlights a rare but life-threatening complication of octreotide-induced bradycardia. Octreotide reduces portal pressures by inducing splanchnic vasoconstriction, thereby controlling variceal bleeding. However, its inhibition of glucagon and intrinsic negative chronotropic effects can predispose susceptible patients to brady-arrhythmias. In this case, the combination of octreotide-induced bradycardia, septic shock, and vasopressor dependence created a precarious hemodynamic state, ultimately leading to cardiac arrest. Clinicians should carefully weigh the risks and benefits of Octreotide, ensure continuous cardiac monitoring, and consider early multidisciplinary involvement when hemodynamic instability arises. Early recognition and timely discontinuation may improve outcomes in rare but serious adverse events associated with octreotide. This abstract is funded by: None
Vorla et al. (Fri,) studied this question.