{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:44:59Z","timestamp":1792028699143,"version":"4.4.0"},"reference-count":0,"publisher":"The Korean Society of Anesthesiologists","content-domain":{"domain":["anesth-pain-med.org"],"crossmark-restriction":true},"short-container-title":["Anesth Pain Med"],"abstract":"<jats:p>Background: Hemorrhagic shock typically presents with tachycardia; however, profound hypovolemia can paradoxically induce bradycardia via the Bezold\u2013Jarisch reflex. This can lead to misdiagnosis of vasovagal syncope, causing dangerous treatment delays.Case: A 50-year-old woman developed profound bradycardia and hypotension after vomiting in the post-anesthesia care unit after undergoing hysterectomy. Despite initial management of vasovagal syncope, her condition remained refractory to vasopressors. A critically low hemoglobin level of 5.5 g\/dL strongly suggested massive occult hemorrhage. She underwent emergency laparotomy for a 1,500 ml pelvic hematoma and recovered without complications.Conclusions: Paradoxical bradycardia is a rare, but life-threatening, sign of occult hemorrhage. Clinicians must maintain a high index of suspicion for hemorrhage when hemodynamic instability is refractory to standard vagal management.<\/jats:p>","DOI":"10.17085\/apm.26633","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:02:31Z","timestamp":1792026151000},"update-policy":"https:\/\/doi.org\/10.17085\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Paradoxical bradycardia from occult venous hemorrhage mimicking vasovagal syncope - A case report -"],"prefix":"10.17085","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8494-6295","authenticated-orcid":true,"given":"Jaehun","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4422-1466","authenticated-orcid":true,"given":"Geal Hong","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0347-1799","authenticated-orcid":true,"given":"Heejung","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2573","published-online":{"date-parts":[[2026,10,15]]},"container-title":["Anesthesia and Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/anesth-pain-med.org\/upload\/pdf\/apm-26633.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:02:32Z","timestamp":1792026152000},"score":1,"resource":{"primary":{"URL":"http:\/\/anesth-pain-med.org\/journal\/view.php?doi=10.17085\/apm.26633"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":0,"URL":"https:\/\/doi.org\/10.17085\/apm.26633","relation":{},"ISSN":["1975-5171","2383-7977"],"issn-type":[{"value":"1975-5171","type":"print"},{"value":"2383-7977","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"assertion":[{"value":"2026-04-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-29","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-15","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}}]}}