Brugada syndrome: Difference between revisions
Neil.m.young (talk | contribs) No edit summary |
Neil.m.young (talk | contribs) No edit summary |
||
| Line 27: | Line 27: | ||
==Disposition== | ==Disposition== | ||
*Needs electrophysiology c/s and EP lab | *Needs electrophysiology c/s and EP lab | ||
* | *Inpatient vs outpatient ICD placement | ||
**Mortality around 10% per year without ICD placement{{Citation needed|reason=Reliable source needed|date=March 2016}} | **Mortality around 10% per year without ICD placement{{Citation needed|reason=Reliable source needed|date=March 2016}} | ||
**Antidysrhythmics have no effect on prognosis | **Antidysrhythmics have no effect on prognosis | ||
Revision as of 15:18, 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
- Cardiology consultation
Disposition
- Needs electrophysiology c/s and EP lab
- Inpatient vs outpatient ICD placement
- Mortality around 10% per year without ICD placement[citation needed]
- 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.