sudden cardiac death and pulse steroid therapy

Q: When administrated during high pulse glucocorticoid therapy, which of the following is suspected to cause sudden cardiac death? (select one)

A) Beta blocker

B) Calcium channel blocker

C) Hydralazine

D) Diuretic

Answer: D

Sudden death has been suspected in some patients who received high pulse infusions of glucocorticoids like 1gm/day. It is hard to blame high-dose steroids with certainty as most of these patients have multiple other underlying comorbidities. 

It is suspected that the risk may be higher if patients receive diuretics simultaneously. This may be due to electrolyte disturbances, particularly hypokalemia.

#cardiology

Reference:

1. White KP, Driscoll MS, Rothe MJ, Grant-Kels JM. Severe adverse cardiovascular effects of pulse steroid therapy: is continuous cardiac monitoring necessary? J Am Acad Dermatol 1994; 30:768.