A 45-year-old male has been admitted to the hospital for investigation of syncope. He has a MET call for another syncopal episode. His 12 lead ECG is shown below (ECG 2).
a) Describe the ECG changes.
b) What is the most likely diagnosis?
c) What is the underlying pathophysiology?
d) List four clinical situations that can worsen this condition.
Coved ST segment elevation V1 – V2 > 2 mm.
Subsequent negative T wave in the same leads.
Brugada syndrome (Type 1).
A mutation in the cardiac sodium channel gene.
o E.g. Flecainide, Amitriptyline, Lithium, Bupivacaine, Propofol, Alcohol.
The criteria for the diagnosis of Brugada syndrome as well as are explored to a fascinating depth by Edward Burns in his article for LITFL. The time-poor exam candidate will be interested in only the answers to this question:
Clinical situations which can worsen this condition:
Berne, Paola, and Josep Brugada. "Brugada syndrome 2012." Circulation Journal 76.7 (2012): 1563-1571.