While this case demonstrates that PST treatment in MS patients can cause symptomatic bradycardia, it is still a rare adverse event, which makes it questionable as to whether cardiac monitoring should be conducted for all MS patients who receive PST, especially since most PST sessions occur in outpatient settings. Additionally, in most cases, sinus bradycardia is self-limiting, asymptomatic and does not require treatment.4-6

This case study manages to highlight some aspects that are not widely covered in existing adult cardiovascular or MS literature. Firstly, steroid treatment in patients with MS carries the risk of causing acute asymptomatic — and on rare occasion — symptomatic sinus bradycardia. Individual patient history should be taken into account before steroid infusion, such as active cardiac disease, smoking status and concomitant medications. Secondly, is how autonomic involvement of MS can affect the cardiovascular system and could cause postural orthostatic tachycardia syndrome or inappropriate sinus tachycardia.

These findings reinforce the belief that MS care should be longitudinal and collaborative. Fostering a cooperative base of healthcare professionals — primary care practitioners, neurologists, cardiologists, mental health professionals — will serve patients best.