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A CASE OF BRUGADA SYNDROME PRESENTING AS SEIZURE DISORDER
2312 JACC March 21, 2017 Volume 69, Issue 11
FIT Clinical Decision Making A CASE OF BRUGADA SYNDROME PRESENTING AS SEIZURE DISORDER Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision‐Making: Arrhythmias and Electrophysiology Abstract Category: Arrhythmias and Clinical EP Presentation Number: 1206-400 Authors: Abdel Anabtawi, Alice Kim, University of New Mexico, Albuquerque, NM, USA, Brigham and Women’s Hospital, Boston, MA, USA Introduction: Brugada syndrome is a genetic disease that is characterized by abnormal electrocardiogram (ECG) findings and an increased risk of sudden cardiac death. It was named after the Spanish cardiologists Pedro and Josep Brugada. It is the major cause of sudden unexplained death syndrome (SUDS), and is the most common cause of sudden death in young men without known underlying cardiac disease in Thailand and Laos.
Case Presentation: A 56 year old woman who was diagnosed with seizure disorder and started on anti-epileptic medications for two years, presented to an acute care room visit with palpitations. Her palpitations were of a new onset, aggravated by anxiety and seldom associated with dizziness. She remained off seizure medications with no recurrent syncopal episodes until she was walking down the stairs, felt dizzy and passed out. Her physical exam was unremarkable, electrocardiogram showed an incomplete right bundle branch block-like pattern along with spontaneous, coved ST segment elevation in leads V1 and V2, findings compatible with type I Brugada pattern. Discussion: Cardiac syncope in the young frequently presents with symptoms and signs that are typically associated with other causes of transient loss of consciousness, including vasovagal syncope and seizure disorders. Patients presenting with convulsions are sometimes incorrectly treated for epilepsy, as these symptoms may be manifestations of underlying cardiac disease. Brugada syndrome, associated with an elevated risk of developing fatal arrhythmic events, is a disorder characterized by a unique electrocardiographic pattern. The typical clinical presentation mainly involves syncope of unclear cause or sudden cardiac death (SCD). Seizures are uncommon clinical manifestations of Brugada syndrome. Although SCD may be the first presentation, patients may often present with symptoms of palpitations or hemodynamic compromise, such as dizziness, seizure, or syncope, particularly following exertion. They may also be made aware of possibly having the condition due to symptoms in other family members. A thorough history, appropriate investigations and a high index of suspicion remain essential in the assessment of syncope.
FIT Clinical Decision Making A CASE OF BRUGADA SYNDROME PRESENTING AS SEIZURE DISORDER Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision‐Making: Arrhythmias and Electrophysiology Abstract Category: Arrhythmias and Clinical EP Presentation Number: 1206-400 Authors: Abdel Anabtawi, Alice Kim, University of New Mexico, Albuquerque, NM, USA, Brigham and Women’s Hospital, Boston, MA, USA Introduction: Brugada syndrome is a genetic disease that is characterized by abnormal electrocardiogram (ECG) findings and an increased risk of sudden cardiac death. It was named after the Spanish cardiologists Pedro and Josep Brugada. It is the major cause of sudden unexplained death syndrome (SUDS), and is the most common cause of sudden death in young men without known underlying cardiac disease in Thailand and Laos.
Case Presentation: A 56 year old woman who was diagnosed with seizure disorder and started on anti-epileptic medications for two years, presented to an acute care room visit with palpitations. Her palpitations were of a new onset, aggravated by anxiety and seldom associated with dizziness. She remained off seizure medications with no recurrent syncopal episodes until she was walking down the stairs, felt dizzy and passed out. Her physical exam was unremarkable, electrocardiogram showed an incomplete right bundle branch block-like pattern along with spontaneous, coved ST segment elevation in leads V1 and V2, findings compatible with type I Brugada pattern. Discussion: Cardiac syncope in the young frequently presents with symptoms and signs that are typically associated with other causes of transient loss of consciousness, including vasovagal syncope and seizure disorders. Patients presenting with convulsions are sometimes incorrectly treated for epilepsy, as these symptoms may be manifestations of underlying cardiac disease. Brugada syndrome, associated with an elevated risk of developing fatal arrhythmic events, is a disorder characterized by a unique electrocardiographic pattern. The typical clinical presentation mainly involves syncope of unclear cause or sudden cardiac death (SCD). Seizures are uncommon clinical manifestations of Brugada syndrome. Although SCD may be the first presentation, patients may often present with symptoms of palpitations or hemodynamic compromise, such as dizziness, seizure, or syncope, particularly following exertion. They may also be made aware of possibly having the condition due to symptoms in other family members. A thorough history, appropriate investigations and a high index of suspicion remain essential in the assessment of syncope.