Whats Wrong Here???

I read a story yesterday in the news about a Columbus man who collapsed during the Columbus half-marathon.  He was taken to Grant Hospital in full arrest.  He was successfully resuscitated and is, according to the news story, still alive.  When they did his EKG they discovered he had Brugada Syndrome.  I thought it might be useful to review a few important details about Brugada Syndrome in this week’s “in the news.”

1.  It is one of the most common causes of sudden cardiac death. The fatal rhythm is ventricular fibrillation.

2.  There are three commonly recognized forms of Brugada:

As you can see, in type 1, the changes are very obvious (RBBB pattern with ST elevation in V1-3.)  The changes are more subtle in type 2 and 3.  Type 2 has a saddle back pattern with a least 2 mm J-point elevation and at least 1 mm ST elevation with a positive or biphasic T-wave.Type 3 has a saddle back pattern with less than 2 mm J-point elevation and less than 1 mm ST elevation with a positive T-wave.

3.  The disorder arises from a mutation in the sodium channel.

4.  These patients are treated with an AICD (defibrillator).

5.  When we order an EKG on someone (especially a young patient) in the ED after syncope, this is one of the major conditions we are looking for.

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4 thoughts on “Whats Wrong Here???

  1. Good point. Cured with AICD placment. The other EKG abnormality in a young person you are looking for after syncope is prolonged QTC. This, if not from a reversible problem like electrolyte disorder, is also treated with an AICD.

    Another syncope cause in young people to consider is Hypertrophic Cardiomyopathy. This is something to especially consider in young person with exertional syncope. I think you see LVH on EKG but I’m not sure. I don’t think their is a classic EKG however like in Brugada.

    Brugada is often confused with Wellens which is totally different except the EKG findings are in V1/V2 like brugada. Wells is a proximal LAD lesion that has a biphasic T wave in V1/V2. These are important to find as you should to a CT coronary angiogram or traditional angiogram instead of a stress test when working them up.

  2. So, if a patient with Brugada is prone to SCD, is his risk associated with exercise as it would be in a patient with coronary ischemia or HOCM? I guess my question is: if you have a rhythm instability, is your AICD more likely to need to fire when you are exercising, or is the “marathon” component of this case a red herring?

    Thanks

    1. Dave, you’re right! This rhythm can appear and disappear for a variety of reasons. I was talking with one of the hospitalists who was telling me about a guy who would demonstrate Brugada with fever!

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