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Atypical electrocardiographic presentation of Brugada syndrome
Atypical electrocardiographic presentation of Brugada syndrome Andrea Giuseppe Porto M.D., Ermanno Dametto M.D., Rita Piazza M.D., Andreea Dragos M.D., Matteo Perfetti M.D., Guglielmo Bernardi M.D. PII: DOI: Reference:
S0167-5273(16)31837-X doi: 10.1016/j.ijcard.2016.08.125 IJCA 23392
To appear in:
International Journal of Cardiology
Received date: Accepted date:
9 July 2016 5 August 2016
Please cite this article as: Porto Andrea Giuseppe, Dametto Ermanno, Piazza Rita, Dragos Andreea, Perfetti Matteo, Bernardi Guglielmo, Atypical electrocardiographic presentation of Brugada syndrome, International Journal of Cardiology (2016), doi: 10.1016/j.ijcard.2016.08.125
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Atypical electrocardiographic presentation of Brugada syndrome
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Dear Editor,
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we present a 69-years-old diabetic man with no familial history of cardiovascular diseases who was admitted for syncope during epigastric pain and hyperthermia (body temperature 38.5°C). Blood pressure was 110/75 mmHg and oxygen saturation was normal. The ECG on admission (Figure 1-A) showed sinus tachycardia (heart rate 120 bpm), first degree atrio-ventricular block, nonspecific intra-ventricular block, ST-segment elevation in inferior leads, and slight ST-segment depression in leads V2 and V3. Emergent coronary angiography showed diffuse subcritical coronary disease and no percutaneous intervention was performed (Video 1). The patient was transferred to the coronary care unit. He was still febrile (body temperature 38 °C) and the ECG was unchanged. Echocardiogram showed mild concentric hypertrophy and no regional wall motion abnormalities or significant valve dysfunction. Serial troponin measurements were negative. The ECG recorded 2 hours after paracetamol administration and body temperature normalization showed regression of both intraventricular block and inferior ST-segment abnormalities (Figure 1-B). The following day the patient experienced diarrhoea, body temperature rose up to 39.5° and C-reactive protein reached 55 mg/dL. ECG showed recurrence of a coved ST-segment elevation in inferior leads which appeared also in V1 (Figure 1-C). Simultaneously, telemetry monitoring showed phases of third degree atrio-ventricular block with asystolic phases up to 10 seconds in duration (Figure 1-D), which were successfully managed with atropine. The intestinal infection was successfully treated with i.v. antibiotic therapy, and the following days the patient remained stable and afebrile. Fifteen days later, electrophysiological testing showed pathologic infra-Hisian conduction (HV-interval 68 milliseconds). Ajmaline testing disclosed a type I Brugada pattern (Figure 2) and also induced a pulseless, sustained wide complex tachyarrhythmia (Figure 3), which was resolved with bicarbonate and isoprenaline infusion. An intracardiac cardioverter-defibrillator was implanted. Brugada syndrome manifestation can be triggered by sepsis and it can show ST-segment elevation in inferior leads [1]. In our case report, this rare presentation simulated an inferior ST-elevation myocardial infarction.
1] Maury P, Moreau A, Hidden-Lucet F, et al. Novel SCN5A mutations in two families with "Brugada-like" ST elevation in the inferior leads and conduction disturbances. J Interv Card Electrophysiol. 2013;37:131-140.
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Figure 3
S0167-5273(16)31837-X doi: 10.1016/j.ijcard.2016.08.125 IJCA 23392
To appear in:
International Journal of Cardiology
Received date: Accepted date:
9 July 2016 5 August 2016
Please cite this article as: Porto Andrea Giuseppe, Dametto Ermanno, Piazza Rita, Dragos Andreea, Perfetti Matteo, Bernardi Guglielmo, Atypical electrocardiographic presentation of Brugada syndrome, International Journal of Cardiology (2016), doi: 10.1016/j.ijcard.2016.08.125
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Atypical electrocardiographic presentation of Brugada syndrome
T
Dear Editor,
References
AC
CE P
TE
D
MA
NU
SC R
IP
we present a 69-years-old diabetic man with no familial history of cardiovascular diseases who was admitted for syncope during epigastric pain and hyperthermia (body temperature 38.5°C). Blood pressure was 110/75 mmHg and oxygen saturation was normal. The ECG on admission (Figure 1-A) showed sinus tachycardia (heart rate 120 bpm), first degree atrio-ventricular block, nonspecific intra-ventricular block, ST-segment elevation in inferior leads, and slight ST-segment depression in leads V2 and V3. Emergent coronary angiography showed diffuse subcritical coronary disease and no percutaneous intervention was performed (Video 1). The patient was transferred to the coronary care unit. He was still febrile (body temperature 38 °C) and the ECG was unchanged. Echocardiogram showed mild concentric hypertrophy and no regional wall motion abnormalities or significant valve dysfunction. Serial troponin measurements were negative. The ECG recorded 2 hours after paracetamol administration and body temperature normalization showed regression of both intraventricular block and inferior ST-segment abnormalities (Figure 1-B). The following day the patient experienced diarrhoea, body temperature rose up to 39.5° and C-reactive protein reached 55 mg/dL. ECG showed recurrence of a coved ST-segment elevation in inferior leads which appeared also in V1 (Figure 1-C). Simultaneously, telemetry monitoring showed phases of third degree atrio-ventricular block with asystolic phases up to 10 seconds in duration (Figure 1-D), which were successfully managed with atropine. The intestinal infection was successfully treated with i.v. antibiotic therapy, and the following days the patient remained stable and afebrile. Fifteen days later, electrophysiological testing showed pathologic infra-Hisian conduction (HV-interval 68 milliseconds). Ajmaline testing disclosed a type I Brugada pattern (Figure 2) and also induced a pulseless, sustained wide complex tachyarrhythmia (Figure 3), which was resolved with bicarbonate and isoprenaline infusion. An intracardiac cardioverter-defibrillator was implanted. Brugada syndrome manifestation can be triggered by sepsis and it can show ST-segment elevation in inferior leads [1]. In our case report, this rare presentation simulated an inferior ST-elevation myocardial infarction.
1] Maury P, Moreau A, Hidden-Lucet F, et al. Novel SCN5A mutations in two families with "Brugada-like" ST elevation in the inferior leads and conduction disturbances. J Interv Card Electrophysiol. 2013;37:131-140.
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Figure 3