EKG of the Week 2018 6-24

This EKG comes courtesy of Dr. Lukasz Cygan.

A 43 year old male with no past medical history presented with lightheadedness. He thought the symptoms were worsened by a sour patch candy. He had no chest pain or palpitations.

His vital signs were normal. His EKG is below.

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1.       What does the EKG demonstrate?

2.       What is the management of this condition?

 

ANSWER:

The EKG shows high take off ST elevations in leads V1 and V2 with a gradually descending ST segment. This is consistent with Brugada type II.

Brugada syndrome is managed with ICD placement. There is no direct treatment for Brugada syndrome.

 

The EKG shows high take off ST elevations in leads V1 and V2 with a gradually descending ST segment. This is sometimes referred to as a “saddle back configuration”. This is consistent with Brugada type II.

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 or near-syncopal episode who have an EKG pattern consistent with Brugada syndrome must be suspected of having had an episode of V-tach.

Brugada type I presents with downsloping, or “coved”, 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.

There is no specific treatment for Brugada syndrome. So, these patients require placement of an ICD to manage their ventricular arrhythmias.

Our patient went to the EP lab and the diagnosis of Brugada was confirmed. He had an ICD placed and is doing well. The sour patch candy was likely a red herring.