Fever-induced ST-segment elevation and T-wave alternans in a patient with Brugada syndrome

A prominent coved or saddle-shaped ST-segment elevation followed by T wave changes in V1-V3 and in the absence of other identifiable cause is termed as Brugada pattern. This pattern in the presence of documented ventricular arrhythmias or its symptoms (syncope, seizure) or significant family for sudden cardiac death or abovementioned ECG changes is called Brugada syndrome. Here we present a comprehensive literature review on the precipitation factors of Brugada syndrome/pattern by various stimuli, its presentation, associations, management and outcomes. We are also presenting a unique case of Brugada pattern where the patient’s Brugada pattern was unmasked at an extreme old age by infection.

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T-WAVE ALTERNANS (TWA) IS ASSOCIATED WITH CARDIOVASCULAR MORTALITY AND NSVT IN THE MERLIN-TIMI 36 TRIAL OF RANOLAZINE VERSUS PLACEBO IN PATIENTS WITH NON-ST SEGMENT elevation ACUTE CORONARY SYNDROME

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(13)60257-0 ◽

2013 ◽

Vol 61 (10) ◽

pp. E257 ◽

Cited By ~ 2

Author(s):

Benjamin Scirica ◽

Tuomo Nieminen ◽

Jose RM Pegler ◽

Caio Tavares ◽

Vitor PF Pagotto ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cardiovascular Mortality ◽

St Segment Elevation ◽

Coronary Syndrome ◽

T Wave ◽

St Segment ◽

T Wave Alternans ◽

Elevation Acute Coronary Syndrome

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Intermittent Brugada Syndrome Presenting with Syncope in an Adult Female

Case Reports in Emergency Medicine ◽

10.1155/2014/742076 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

Patricia Chavez ◽

Daniel Bamira ◽

Abel Casso Dominguez ◽

Akshai Bhandary ◽

Eyal Herzog

Keyword(s):

Brugada Syndrome ◽

Fatal Outcome ◽

Structural Heart Disease ◽

Bundle Branch Block ◽

St Segment Elevation ◽

T Wave ◽

Shockable Rhythm ◽

St Segment ◽

History Of

Background.Brugada syndrome accounts for 4–12% of all sudden deaths worldwide and at least 20% of sudden deaths in patients with structurally normal hearts.Case Report.A 48-year-old female presented to the emergency department after two witnessed syncopal episodes. While awaiting discharge had a third collapse followed by cardiac arrest with shockable rhythm. Initial electrocardiogram showed wide QRS complex with left axis deviation, ST-segment elevation of <1 mm in V1 and V2, and flattening of T waves in V1. The angiogram did not demonstrate obstructive coronary disease. The electrocardiogram obtained two days after these events showed a right bundle branch block with ST-segment elevation of >2 mm followed by a negative T wave with no isoelectric separation, suggestive of spontaneous intermittent Brugada type 1 pattern. Cardiac magnetic resonance imaging demonstrated neither structural heart disease nor abnormal myocardium. After placement of an implantable cardioverter defibrillator the patient was discharged. Why should an emergency physician be aware of this? Brugada syndrome is an infrequently encountered clinical entity which may have a fatal outcome. This syndrome primarily presents with syncope. It should be considered as a component of differential diagnosis in patients with family history of syncope and sudden cardiac death.

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Relation of T-Wave Alternans to Mortality and Nonsustained Ventricular Tachycardia in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome from the MERLIN-TIMI 36 Trial of Ranolazine Versus Placebo

The American Journal of Cardiology ◽

10.1016/j.amjcard.2014.03.056 ◽

2014 ◽

Vol 114 (1) ◽

pp. 17-23 ◽

Cited By ~ 16

Author(s):

Tuomo Nieminen ◽

Benjamin M. Scirica ◽

Jose R.M. Pegler ◽

Caio Tavares ◽

Vitor P.F. Pagotto ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Ventricular Tachycardia ◽

St Segment Elevation ◽

Nonsustained Ventricular Tachycardia ◽

Coronary Syndrome ◽

T Wave ◽

St Segment ◽

T Wave Alternans ◽

Elevation Acute Coronary Syndrome

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The mortal cause of sudden ECG changes in patients with chronic aortic insufficiency: Aortic dissection

Interventional Medicine and Applied Science ◽

10.1556/1646.10.2018.50 ◽

2019 ◽

Vol 11 (1) ◽

pp. 68-70

Author(s):

Mahmut Yesin ◽

Turgut Karabağ ◽

Macit Kalçık ◽

Süleyman Karakoyun ◽

Metin Çağdaş ◽

...

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Signs And Symptoms ◽

Aortic Insufficiency ◽

Ecg Changes ◽

St Segment Elevation ◽

T Wave ◽

Wave Inversion ◽

St Segment ◽

High Index Of Suspicion

The symptoms of aortic dissection (AD) may be highly variable and may mimic other much common conditions. Thus, a high index of suspicion should be maintaned, especially when the risk factors for AD are present or signs and symptoms suggest this possibility. However, sometimes AD may be asymptomatic or progression may be subclinical. Various electrocardiographical (ECG) changes may be seen in AD patients such as ST segment elevation in aVR as well as ST segment depression and T-wave inversion. In this case report, we reported a patient with acute AD whose ECG revealed ST segment elevation in aVR lead in addition to diffuse ST segment depression in other leads.

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Fever Unmasked Brugada Syndrome in Pediatric Patient: A Case Report

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.2.44418 ◽

2020 ◽

Vol 4 (2) ◽

pp. 244-246

Author(s):

Orhay Mirzapolos ◽

Perry Marshall ◽

April Brill

Keyword(s):

Emergency Medicine ◽

Case Report ◽

Brugada Syndrome ◽

Ventricular Arrhythmias ◽

Cardiac Monitoring ◽

St Segment Elevation ◽

Cardioverter Defibrillator ◽

St Segment ◽

Viral Illness ◽

Automatic Implantable Cardioverter Defibrillator

Introduction: Brugada syndrome is an arrhythmogenic disorder that is a known cause of sudden cardiac death. It is characterized by a pattern of ST segment elevation in the precordial leads on an electrocardiogram (EKG) due to a sodium channelopathy. Case Report: This case report highlights the case of a five-year-old female who presented to the emergency department with a febrile viral illness and had an EKG consistent with Brugada syndrome. Discussion: Fever is known to accentuate or unmask EKG changes associated with Brugada due to temperature sensitivity of the sodium channels. Conclusion: Febrile patients with Brugada are at particular risk for fatal ventricular arrhythmias and fevers should be treated aggressively by the emergency medicine provider. Emergency medicine providers should also consider admitting febrile patients with Brugada syndrome who do not have an automatic implantable cardioverter-defibrillator for cardiac monitoring.

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Abstract 4840: Tako-Tsubo Cardiomyopathy without Apical Ballooning - Results of the German Tako-Tsubo Registry

Circulation ◽

10.1161/circ.118.suppl_18.s_947-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Anastasios Athanasiadis ◽

Birke Schneider ◽

Johannes Schwab ◽

Uta Gottwald ◽

Ellen Hoffmann ◽

...

Keyword(s):

Coronary Artery ◽

Ejection Fraction ◽

Wall Motion ◽

Apical Ballooning ◽

Left Ventricular ◽

St Segment Elevation ◽

T Wave ◽

Wave Inversion ◽

St Segment ◽

Tako Tsubo Cardiomyopathy

Background : The German tako-tsubo cardiomyopathy (TTC) registry has been initiated to further evaluate this syndrome in a western population. We aimed to assess different patterns of left ventricular involvement in TTC. Methods : Inclusion criteria were: 1) acute chest symptoms, 2) reversible ECG changes (ST-segment elevation±T-wave inversion), 3) reversible left ventricular dysfunction with a wall motion abnormality not corresponding to a single coronary artery territory, 4) no significant coronary artery stenoses. Results : A total of 258 patients (pts) from 33 centers were included with a mean age of 68±12 years. Left ventriculography revealed the typical pattern of apical ballooning in 170 pts (66%) and an atypical mid-ventricular ballooning with normal wall motion of the apical and basal segments in 88 pts (34%). Mean age (68±11 vs 67±13 years) and gender distribution (150 women/20 men vs 80 women/8 men) were similar in both groups. Triggering events were present in 78% of the pts with apical ballooning (35% emotional, 34 physical and 9% combination) and in 75% of the pts with mid-ventricular ballooning (39% emotional, 25% physical and 11% combination). As assessed by left ventriculography, ejection fraction was significantly lower in pts with mid-ventricular ballooning (50±15% vs 45±13%, p=0.006). There was no difference in right ventricular involvement. Creatine kinase and troponin I were comparable in both groups. The ECG on admission showed ST-segment elevation in 87% of pts with apical ballooning and in 78% of pts with mid-ventricular ballooning. T-wave inversion was seen in 70% of the pts irrespective of the TTC variant. A Q-wave was significantly less present in pts with mid-ventricular ballooning (30% vs 16%, p=0.04). The QTc interval during the first 3 days was not different among both groups. Conclusion : A variant form with mid-ventricular ballooning was observed in one third of the pts with TTC. Left ventricular ejection fraction was significantly lower in these pts, although they revealed significantly less Q-waves on the admission ECG. All other parameters were similar and confirm the concept that apical and mid-ventricular ballooning represent two different manifestations of the same syndrome.

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