A 24 year old male with no past medical history presents after a syncopal episode. He was sitting at home watching TV and the next thing he knew he was on the floor. He does not recall anything about the episode.
V/S: Pulse – 80, Respirations – 16, Blood Pressure 120/80.
He is on no medications and denies drug use.
His EKG is below.
1. What does the EKG demonstrate?
2. How should this patient be managed?
The EKG demonstartes Brugada syndrome
The patient should be admitted and needs placement of an ICD.
The EKG shows downsloping ST elevations in leads V1 and V2 leading into inverted T waves. There is no isoelectric separation between the QRS complex and the T wave. This is consistent with Brugada syndrome.
Brugada syndrome is a genetic (autosomal dominant) sodium channel defect. It predominantly affects males (90%). Patients with Brugada syndrome are at risk for polymorphic V-tach. Patients who had a syncopal episode who have an EKG pattern consistent with Brugada syndrome likely had an episode of V-tach.
There is no specific treatment for Brugada syndrome. So, these patients require placement of an ICD to manage their ventricular arrhythmias.