A 37‐year‐old man with a family history of “heart disease” presented to the emergency room (ER) with a witnessed syncopal event lasting 1 minute. He had no chest pain, dyspnea, dizziness, or palpitations prior to the event, and he returned to consciousness spontaneously. The initial 12‐lead electrocardiogram (ECG) showed anterior ST segment elevations. In the ER, he was diagnosed with an acute myocardial infarction (MI). He received aspirin, a beta‐er, and heparin with a plan to have a left heart catheterization with a possibility of angioplasty and percutaneous intervention. However, prior to the procedure, the on‐call hospitalist and cardiologist reviewed his ECG and took a more detailed history, diagnosing him with Brugada syndrome, not an acute MI. In addition to his ECG results, he met 3 of the 7 clinical criteria of the syndrome, which are documented ventricular fibrillation, self‐terminating ventricular tachycardia, family history of sudden cardiac death, family history of asymptomatic ST elevation on ECG, inducible ventricular tachycardia on electrophysiological study, nocturnal agonal respiration, and unexplained syncope. An electrophysiological study was performed, which confirmed the diagnosis, and he received a defibrillator. Of note, he had a similar episode in 2004 and was diagnosed with an acute MI, and left heart catheterization at that time was normal. He was diagnosed with coronary artery vasospasm and told to take an aspirin daily. His ECGs from 2004 and 2006 were essentially identical.
Brugada syndrome is a familial cause of sudden cardiac death. The prevalence is 0.5%, and the male‐to‐female ratio is 9:1. It has an autosomal dominant mode of inheritance and involves a mutation in the cardiac sodium channel gene (SCN5A). Up to a third of the time, the initial presentation is sudden cardiac death; most other patients present with syncope. An ECG shows ST segment elevation in leads V1‐V3 with an upward convexity and a flipped or biphasic T‐wave. Patients who have this type of ECG are said to have the Brugada pattern, but only those who meet 1 of 7 clinical criteria, as our patient did, have Brugada syndrome.
The treatment of and prognosis for acute ST segment elevation MI and Brugada syndrome are vastly different. The recognition of this syndrome early in presentation is critical in orderto prevent sudden cardiac death. This case demonstrates that an accurate clinical history is still the most important factor in making the correct diagnosis. Brugada syndrome is most often diagnosed in an inpatient setting, making the hospitalist integral in its management.
M. Salameh, None; J. Edelman, None.
To cite this abstract:Salameh M, Edelman J. Brugada Syndrome: An Uncommon Cause of Syncope and Sudden Cardiac Death. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 149. https://www.shmabstracts.com/abstract/brugada-syndrome-an-uncommon-cause-of-syncope-and-sudden-cardiac-death/. Accessed December 10, 2018.