Brugada syndrome: Difference between revisions
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== Background == | ==Background== | ||
*Consider as cause of syncope in pts w/ family history of sudden death | *Consider as cause of syncope in pts w/ family history of sudden death | ||
* | *Autosomal dominant Na-channelopathy which increases the risk of sudden cardiac death (~10%/yr)<ref>Cerrato N, Giustetto C, et al. Prevalence of Type 1 Brugada Electrocardiographic Pattern Evaluated by Twelve-Lead Twenty-Four-Hour Holter Monitoring. The American Journal of Cardiology.115(1). 2015. 52-56.</ref> | ||
*Much more common in men (up to 9x), particularly Southeast Asian males | |||
*Much more common in men (up to 9x) | |||
*ECG shows incomplete [[RBBB]] with [[ST elevation]] in V1-V3 | *ECG shows incomplete [[RBBB]] with [[ST elevation]] in V1-V3 | ||
**In uncomplciated RBBB, usually there no ST change to slight ST depression<ref>Amal Mattu. Mattu ECG Case: March 4 2012. umemergencymed. Published Apr 9, 2012. https://www.youtube.com/watch?v=NJL8An6uO1Y.</ref> | **In uncomplciated RBBB, usually there no ST change to slight ST depression<ref>Amal Mattu. Mattu ECG Case: March 4 2012. umemergencymed. Published Apr 9, 2012. https://www.youtube.com/watch?v=NJL8An6uO1Y.</ref> | ||
**If presenting symptom is chest pain rather than syncope, consider strongly STEMI | **If presenting symptom is chest pain rather than syncope, consider strongly STEMI | ||
== | ==Clinical Features== | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{ST elevation DDX}} | {{ST elevation DDX}} | ||
==Diagnosis== | |||
===ECG Criteria=== | |||
*Note - ''ECG findings can be transient'' | |||
*Type 1-Elevated ST segment (>2mm) descends w/ upward convexity to a TWI | |||
*Type 2-Elevated ST segment (>1mm) descends toward baseline then rises again (saddleback) to upright T wave | |||
*Type 3-Elevated ST segment (<1mm) descends toward baseline then rises again to upright T wave | |||
[[File:Brugada.jpg]] | |||
==Management== | ==Management== | ||
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*Cardiology consultation | *Cardiology consultation | ||
== Disposition == | ==Disposition== | ||
*Needs electrophysiology c/s and EP lab | *Needs electrophysiology c/s and EP lab | ||
*Pt requires admission for ICD placement | *Pt requires admission for ICD placement | ||
Revision as of 03:15, 9 March 2016
Background
- Consider as cause of syncope in pts w/ family history of sudden death
- Autosomal dominant Na-channelopathy which increases the risk of sudden cardiac death (~10%/yr)[1]
- Much more common in men (up to 9x), particularly Southeast Asian males
- ECG shows incomplete RBBB with ST elevation in V1-V3
- In uncomplciated RBBB, usually there no ST change to slight ST depression[2]
- If presenting symptom is chest pain rather than syncope, consider strongly STEMI
Clinical Features
Differential Diagnosis
ST Elevation
- Cardiac
- ST-segment elevation myocardial infarction (STEMI)
- Post-MI (ventricular aneurysm pattern)
- Previous MI with recurrent ischemia in same area
- Wellens' syndrome
- Coronary artery vasospasm (eg, Prinzmetal's angina)
- Coronary artery dissection
- Pericarditis
- Myocarditis
- Aortic dissection in to coronary
- Left ventricular aneurysm
- Left ventricular pseudoaneurysm
- Early repolarization
- Left bundle branch block
- Left ventricular hypertrophy (LVH)
- Myocardial tumor
- Myocardial trauma
- RV pacing (appears as Left bundle branch block)
- Brugada syndrome
- Takotsubo cardiomyopathy
- AVR ST elevation
- Other thoracic
- Metabolic
- Drugs of abuse (eg, cocaine, crack, meth)
- Hyperkalemia (only leads V1 and V2)
- Hypothermia ("Osborn J waves")
- Medications
Diagnosis
ECG Criteria
- Note - ECG findings can be transient
- Type 1-Elevated ST segment (>2mm) descends w/ upward convexity to a TWI
- Type 2-Elevated ST segment (>1mm) descends toward baseline then rises again (saddleback) to upright T wave
- Type 3-Elevated ST segment (<1mm) descends toward baseline then rises again to upright T wave
Management
- IV access
- Cardiac monitor
- Defibrillator at the bedside
- Cardiology consultation
Disposition
- Needs electrophysiology c/s and EP lab
- Pt requires admission for ICD placement
- Mortality around 10% per year without ICD placement
- Antidysrhythmics have no effect on prognosis
See Also
References
- ↑ Cerrato N, Giustetto C, et al. Prevalence of Type 1 Brugada Electrocardiographic Pattern Evaluated by Twelve-Lead Twenty-Four-Hour Holter Monitoring. The American Journal of Cardiology.115(1). 2015. 52-56.
- ↑ Amal Mattu. Mattu ECG Case: March 4 2012. umemergencymed. Published Apr 9, 2012. https://www.youtube.com/watch?v=NJL8An6uO1Y.