BRUGADA SYNDROME- SKATING ON THIN ICE
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 49
Abstract
PRESENTATION OF CASE A 48 years old male patient presented with complaint of sudden-onset chest pain, which was retrosternal and localised. Pain was not associated with sweating or palpitation. Patient gave history of fever 2 days back. There was history of several episodes of palpitation and syncope prior to hospitalisation. No family history of diabetes, hypertension, syncope or sudden death in any of the close relatives was present. On examination, patient was of average built, afebrile with regular pulse rate of 120/ min. Patient was in shock (70/60 mmHg). JVP was not raised with SPO2 of 96%. Systemic examination was normal. With symptomatic treatment, patient’s vital signs improved. Fig. 1 (ECG 1) (Please refer ECG 1) Shows J point elevation with down sloping of ST-segment and T-wave inversion in leads V1 and V2 and sharp pointed S wave without slurring in lead V5. Urgent Echocardiography was done for any Regional Wall Motion Abnormalities (RWMA) to rule out coronary artery disease. Echocardiogram was normal. Trop-T test by kit was negative. Second ECG recorded after 6 hours is shown in Figure 2. Fig. 2 (ECG 2) (Please refer ECG 2) shows ST-segment elevation with saddleback configuration and merging of Twave with ST-segment. Third ECG (Fig. 3) was recorded 12 hrs. after admission. Fig. 3 (ECG 3) (Please refer ECG 3) shows ST-segment elevation < 1 mm with positive T waves in a saddleback configuration in lead V2. These three ECGs show presence of all three types of electrocardiographic patterns of Brugada syndrome. First one is typical Brugada type 1 with classical J point and STelevation. Second one shows saddleback configuration of type II and third one shows < 1 mm ST elevation in V2 with saddleback pattern suggestive of type III Brugada syndrome. Sudden cardiac death is a public health concept incorporating features of natural, rapid and unexpected death. Brugada syndrome accounts for 4-12% of all sudden deaths and ~ 20% of deaths in patients with structurally normal hearts.(1) It is an important cause of sudden unexpected death of men under age of 50 years in regions of world where this inherited syndrome is endemic.(
Authors and Affiliations
Amit Kumar Jha
Keywords
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- EP ID EP549250
- DOI 10.14260/jemds/2018/1178
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