Bisoprolol-induced complete heart block: A Case report

Background: Beta-blockers are prescribed in the management of cardiovascular diseases yet may rarely precipitate life-threatening conduction abnormalities like complete heart block (CHB). Case Presentation: A 68-year-old male with a history of hypertension, diabetes mellitus, CAD post-PTCA, ischemic stroke, and dyslipidemia presented with syncope, bradycardia, and hypotension. ECG showed a third-degree AV block with AV dissociation. Laboratory investigation revealed hyperkalemia, acute kidney injury, diabetic ketoacidosis, sepsis secondary to urinary tract infection, and elevation in troponin I. Bisoprolol was the implicated cause. He was immediately managed with the cessation of bisoprolol, vasopressors and chronotropes, temporary cardiac pacing, insulin therapy, antibiotics, and correction of surrounding metabolic derangements. The patient's rhythm stabilized, renal function improved, and the pacemaker was removed safely prior to discharge. Conclusion: This case underscores bisoprolol-induced CHB occurring in a high-risk patient and accentuates the utmost importance of early detection, prompt withdrawal of the offending drug, and multidisciplinary management for better outcomes. Keywords: Bisoprolol, Complete heart block, Beta-blocker induced bradycardia, Adverse drug reaction, Cardiogenic shock, Clinical pharmacist intervention