EKG of the Week 2017 12-31

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.

2017 12-31.jpg

1.       What does the EKG demonstrate?

2.       How should this patient be managed?

 

ANSWER:

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.