- Consider as cause of syncope in patients with family history of sudden death
- 80% of Brugada syndrome diagnosed only after a cardiac arrest
- Autosomal dominant Na-channelopathy which increases the risk of sudden cardiac death (~10%/yr)
- Much more common in men (up to 9x), particularly Southeast Asian males
- ECG shows incomplete RBBB with ST elevation in V1-V3
- In uncomplicated RBBB, usually there is no ST change to slight ST depression
- If presenting symptom is chest pain rather than syncope, consider strongly STEMI
- Typically asymptomatic
- Patients may have Vfib arrest or sudden death
- Diagnostic ECG findings transient and variable, with only 1/3 of serial ECGs diagnostic in confirmed spontaneous coved-type Brugada syndrome patients
- Myocardial infarct (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
- Drugs of abuse (eg, cocaine, crack, meth)
- Aortic dissection in to coronary
- Left ventricular aneurysm
- Left ventricular pseudoaneurysm
- Early repolarization
- Left bundle branch block
- Left ventricular hypertrophy (LVH)
- Pulmonary Embolism
- Myocardial tumor
- Myocardial trauma
- External compression of artery
- Medications: Tricyclic (TCA) toxicity, Digoxin
- RV pacing (appears as Left bundle branch block)
- Hyperkalemia (only leads V1 and V2)
- Hypothermia ("Osborn J waves")
- Brugada syndrome
- Takotsubo cardiomyopathy
- AVR ST elevation
Note - ECG findings can be transient
- Type 1-Elevated ST segment (>2mm) descends with 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
Other ECG Pearls in Brugada Syndrome
- V1-v2 lead placement in 2nd or 3rd IC spaces (rather than conventional 4th IC space) increases chance of recording type I pattern
- Other factors that increase type I ECG tracings:
- Night time
- After heavy meals
- Recovery phase of exercise
- ECG features placing pt at higher risk for symptomatic Brugada
- Cardiology consultation
- See Electrical storm
- Needs EP consult and VF-inducing electrophysiologic study (EPS), though EPS is controversial prognosticator
- Inpatient vs outpatient ICD placement
- Certain drugs must be avoided in pts with Brugada syndrome
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