Brugada-like electrocardiogram pattern in a young man taking a proton-pump inhibitor

The Brugada syndrome (BrS) is an electrical heart disease with complex inheritance (some cases with SCN5A mutations), characterized by specific electrocardiogram (ECG) markers and high risk of associated lethal ventricular arrhythmias [1]. The ECG signature of BrS consists of right precordial ST-segment elevation (≥2 mm) followed by negative T waves [1]. It sometimes includes the findings of right bundle branch block (RBBB). In certain cases, the typical ECG pattern is present intermittently which creates a potential problem for reaching the diagnosis of BrS. Another problem in diagnosing BrS is the presence of so-called Brugada phenocopies (BrPs), i.e. an acquired Brugada-like ECG pattern that are visually identical and indistinguishable from true BrS [2]. This ECG pattern can be caused by other conditions including ischemia of the ventricular septum and/or right ventricle or by taking certain medications [2]. Proton-pump inhibitors (PPIs) are widely prescribed, often for prolonged use, and have been associated with electrolyte disturbances and cardiac arrhythmias [3,4]. We hereby present for the first time the case of a patient with an ECG suggestive of BrS while taking PPI; but no other medication known to cause BrS. The BrS ECG pattern disappeared a few months after stopping the medication.

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Hyperkalemia Induced Brugada Phenocopy: A Rare ECG Manifestation

Case Reports in Cardiology ◽

10.1155/2017/9464728 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Muhammad Ameen ◽

Ghulam Akbar ◽

Naeem Abbas ◽

Ghazi Mirrani

Keyword(s):

Ion Channels ◽

Ventricular Arrhythmias ◽

Cardiac Conduction ◽

St Segment Elevation ◽

Electrolyte Disturbances ◽

Cardiac Ion Channels ◽

St Segment ◽

Life Threatening ◽

Severe Hyperkalemia ◽

Brugada Pattern

Brugada syndrome (BrS) is an inherited disorder of cardiac ion channels characterized by peculiar ECG findings predisposing individuals to ventricular arrhythmias, syncope, and sudden cardiac death (SCD). Various electrolyte disturbances and ion channels blocking drugs could also provoke BrS ECG findings without genetic BrS. Clinical differentiation and recognition are essential for guiding the legitimate action. Hyperkalemia is well known to cause a wide variety of ECG manifestations. Severe hyperkalemia can even cause life threatening ventricular arrhythmias and cardiac conduction abnormalities. Most common ECG findings include peaked tall T waves with short PR interval and wide QRS complex. Since it is very commonly encountered disorder, physicians need to be aware of even its rare ECG manifestations, which include ST segment elevation and Brugada pattern ECG (BrP). We are adding a case to the limited literature about hyperkalemia induced reversible Brugada pattern ECG changes.

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Reversible Cocaine-Induced Brugada Pattern in a Middle-Aged Man with Chest Pain

International Cardiovascular Forum Journal ◽

10.17987/icfj.v4i0.141 ◽

2015 ◽

Vol 4 ◽

pp. 77

Author(s):

Saira Imran ◽

Maxwell Afari ◽

Ameya Hodarkar ◽

Fady Y. Marmoush ◽

Alice Y. Kim

Keyword(s):

Chest Pain ◽

Ventricular Arrhythmias ◽

Autosomal Dominant ◽

Sudden Cardiac Arrest ◽

Type Ii ◽

Autosomal Dominant Disorder ◽

Bundle Branch Block ◽

St Segment Elevation ◽

St Segment ◽

Brugada Pattern

<p>Brugada syndrome is an autosomal dominant disorder, characterized by electrocardiographic manifestations of a pseudo right bundle branch block and a distinctive ST segment elevation in the precordial leads, with a predisposition to ventricular arrhythmias and sudden cardiac arrest. Many medications and toxins have been reported to induce a Brugada pattern on electrocardiogram. We report a case of a patient who presented with chest pain and was found to have electrocardiographic manifestation of Brugada type II in the setting of cocaine use and chest pain.</p>

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Intraventricular conduction defects in patients with st-segment elevation myocardial infarction – the paradox of right bundle branch block

European Heart Journal ◽

10.1093/ehjci/ehaa946.1615 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Fernandes ◽

F Montenegro ◽

M Cabral ◽

R Carvalho ◽

L Santos ◽

...

Keyword(s):

Hospital Mortality ◽

Right Bundle Branch Block ◽

Independent Predictor ◽

Left Ventricular Ejection ◽

Bundle Branch Block ◽

Hospital Outcomes ◽

St Segment Elevation ◽

Intraventricular Conduction ◽

St Segment ◽

Worse Prognosis

Abstract Intraventricular conduction defects (IVCD) in patients with acute myocardial infarct (AMI) are predictors of a worse prognosis. When acquired they can be the result of an extensive myocardial damage. Purpose To assess the impact of IVCD, regardless of being previously known or presumed new, on in-hospital outcomes of patients with AMI with ST segment elevation (STEMI) or undetermined location. Methods From a series of patients included in the National Registry of Acute Coronary Syndrome between 10/1/2010 and 9/1/2019, were selected patients with STEMI or undetermined AMI, undergoing coronary angiography. Results 7805 patients were included: 461 (5.9%) presenting left bundle branch block (LBBB), 374 (4.8%) with right bundle branch block (RBBB) and 6970 (89.3%) with no IVCD. Clinical characteristics as well as in-hospital outcomes are described in the table 1. An unexpected worse prognosis in patients with RBBB has motivated a multivariate analysis. RBBB remained an independent predictor of in-hospital mortality (OR 1.91, 95% CI 1.04–3.50, p=0.038), along with female gender (OR 1.73, 95% CI 1.11–2.68, p=0.015), Killip Class>1 (OR 2.26, 95% CI 1.45–3.53, p<0.001), left ventricular ejection fraction <50% (OR 3.93, 95% CI 2.19–7.05, p<0.001) and left anterior descending artery as the culprit lesion (OR 1.85, 95% CI 1.16–2.91, p=0.009). Conclusion In spite of an apparent better clinical profile, in the current large series of unselected STEMI patients, the presence of RBBB is associated with the worst in-hospital outcome. RBBB doubles the risk of death, being an independent predictor of in-hospital mortality. Funding Acknowledgement Type of funding source: None

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Midventricular takotsubo syndrome: different dyskinesia location leading to a different electrocardiogram?

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.123 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

M Padilla Lopez ◽

A Duran Cambra ◽

M Vidal Burdeus ◽

L Rodriguez Sotelo ◽

J Sanchez Vega ◽

...

Keyword(s):

Acute Phase ◽

Clinical Symptoms ◽

Takotsubo Syndrome ◽

St Segment Elevation ◽

Funding Sources ◽

Wave Inversion ◽

St Segment ◽

Electrocardiogram Ecg ◽

Study Inclusion

Abstract Funding Acknowledgements Type of funding sources: None. Background Takotsubo syndrome (TKS) is characterized by the appearance of apical reversible dyskinesia in its typical form. Electrocardiogram (ECG) in the acute phase (<12 from symptom onset) generally shows anterior ST segment elevation. Nonetheless, other atypical forms of TKS have been described depending on the location of the dyskinetic segments, such as, mid-ventricular, basal and focal forms. Considering the different segments involved in these atypical forms, it seems reasonable to consider that ST changes in acute phase ECG could be different. Purpose To compare ECG in the acute phase of typical TKS versus mid-ventricular TKS, as it was the more frequent form of atypical TKS in our registry. Methods Patients included in the prospective TKS registry of our center according to the Mayo Clinic diagnostic criteria, with the first ECG performed less than 12 hours from the symptoms onset were reviewed. All cardiac left ventriculographies were reviewed to ensure a correct classification of the different types of TKS. Results A total of 297 patients were included in our local registry. 80 patients met our study inclusion criteria. 56 ECGs of typical apical TKS were compared to 24 ECGs of atypical midventricular TKS. There were no differences between the baseline characteristics in both groups, except for mid-ventricular TKS, that was more frequently triggered by physical stressor. Regarding the ECG analysis, the main difference found in our serie was related to ST-segment deviation (Table 1). While ST-segment elevation was more common in typical TKS than in atypical TKS (73% vs 50%), ST-segment depression (generally in inferior leads) was observed in 54% of patients with atypical TKS and in no patient with typical TKS (figure 1). Conclusion The different location of dyskinesia between typical TKS and mid-ventricular TKS is associated to significant differences in the ECG obtained in the first hours after the onset of the clinical symptoms. The presence of ST-segment depression is highly suggestive of mid-ventricular TKS. ECG characteristicsTypical (n = 56)Midventricular (n = 24)pSTe > 1mm, no (%)41 (73)12 (50)0,044STd >0,5 mm, no (%)013 (54)< 0,001T wave inversion, no (%)12 (21)4 (17)0,626Q wave, no (%)22 ( 39)12 (50)0,374cQT, mean (SD)445 (54)438 (37)0,578QRS low voltages*, n (%)9 ( 16)1 (4)0,328STe ST-segment elevation, STd: ST-segment depression, cQT: corrected QT interval *Voltages <5mm in all limb leads or <10mm in all precordial leads Abstract Figure. 12-lead ECG and left ventriculography

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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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Right Ventricular Compression Mimicking Brugada-Like Electrocardiogram in a Patient with Recurrent Pectus Excavatum

Case Reports in Cardiology ◽

10.1155/2017/3047937 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Jinhee Ahn ◽

Jong-Il Choi ◽

Jaemin Shim ◽

Sung Ho Lee ◽

Young-Hoon Kim

Keyword(s):

Pectus Excavatum ◽

Surgical Correction ◽

Mechanical Compression ◽

St Segment Elevation ◽

Skeletal Anomaly ◽

St Segment ◽

Chest Deformity ◽

The Right ◽

Electrocardiogram Ecg ◽

Benign Course

Pectus excavatum (PE), the most common skeletal anomaly of chest wall, sometimes requires a surgical correction but recurrent PE is not uncommon. PE usually has a benign course; however, this chest deformity may be associated with symptomatic tachyarrhythmias due to mechanical compression. We report a case of a patient with recurrent PE after surgical correction presenting with palpitation and electrocardiogram (ECG) showing ST-segment elevation on the right precordial leads, which could be mistaken for a Brugada syndrome (BrS).

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Right Bundle Branch Block, Right Precordial ST-Segment Elevation, and Sudden Death in Young People

Circulation ◽

10.1161/01.cir.103.5.710 ◽

2001 ◽

Vol 103 (5) ◽

pp. 710-717 ◽

Cited By ~ 140

Author(s):

Domenico Corrado ◽

Cristina Basso ◽

Gianfranco Buja ◽

Andrea Nava ◽

Lino Rossi ◽

...

Keyword(s):

Young People ◽

Sudden Death ◽

Right Bundle Branch Block ◽

Bundle Branch Block ◽

St Segment Elevation ◽

St Segment

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Les facteurs cliniques qui influencent le pronostic post-infarctus à un an

Canadian Journal of Applied Physiology ◽

10.1139/h93-007 ◽

1993 ◽

Vol 18 (1) ◽

pp. 63-79

Author(s):

Sylvie Robichaud-Ekstrand

Keyword(s):

Ventricular Arrhythmias ◽

Prognostic Value ◽

Left Ventricular ◽

Cardiac Events ◽

Mortality And Morbidity ◽

St Segment Elevation ◽

St Segment ◽

Prognostic Stratification ◽

History Of ◽

Exercise Induced

Many clinical factors influence the 1-year prognosis in myocardial infarction (MI) patients. The most important clinical determinants are the left ventricular dysfunction, myocardial ischemia, and complex ventricular arrhythmias. Some authors have found an independent prognostic value of complex ventricular arrhythmias, while others consider that ventricular arrhythmias predict future cardiac events only if associated with low ejection fractions. Other factors that have 1-year prognostic value are the following: a previous MI, a history of angina at least 3 months preceding the infarct, postmyocardial angina, and the criteria that indicate to the practitioner whether MI patients are medically ineligible for stress testing. There still remain controversies in regard to the predictive value of certain variables such as the site, type, and extension of the MI, the presence of complex ventricular arrhythmias, exercise-induced hypotension, ST segment elevation, and the electrical provocation of dangerous arrhythmias. Key words: cardiac rehabilitation, postinfarct mortality and morbidity, cardiac events predictors, postinfarct prognostic stratification

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The stress hyperglycaemia ratio is associated with left ventricular remodelling after first acute ST-segment elevation myocardial infarction

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01889-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shuai Meng ◽

Yong Zhu ◽

Kesen Liu ◽

Ruofei Jia ◽

Jing Nan ◽

...

Keyword(s):

Myocardial Infarction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Stress Hyperglycaemia ◽

St Segment ◽

Significant Difference ◽

First Time

Abstract Background Left ventricular negative remodelling after ST-segment elevation myocardial infarction (STEMI) is considered as the major cause for the poor prognosis. But the predisposing factors and potential mechanisms of left ventricular negative remodelling after STEMI remain not fully understood. The present research mainly assessed the association between the stress hyperglycaemia ratio (SHR) and left ventricular negative remodelling. Methods We recruited 127 first-time, anterior, and acute STEMI patients in the present study. All enrolled patients were divided into 2 subgroups equally according to the median value of SHR level (1.191). Echocardiography was conducted within 24 h after admission and 6 months post-STEMI to measure left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD). Changes in echocardiography parameters (δLVEF, δLVEDD, δLVESD) were calculated as LVEF, LVEDD, and LVESD at 6 months after infarction minus baseline LVEF, LVEDD and LVESD, respectively. Results In the present study, the mean SHR was 1.22 ± 0.25 and there was significant difference in SHR between the 2 subgroups (1.05 (0.95, 1.11) vs 1.39 (1.28, 1.50), p < 0.0001). The global LVEF at 6 months post-STEMI was significantly higher in the low SHR group than the high SHR group (59.37 ± 7.33 vs 54.03 ± 9.64, p = 0.001). Additionally, the global LVEDD (49.84 ± 5.10 vs 51.81 ± 5.60, p = 0.040) and LVESD (33.27 ± 5.03 vs 35.38 ± 6.05, p = 0.035) at 6 months after STEMI were lower in the low SHR group. Most importantly, after adjusting through multivariable linear regression analysis, SHR remained associated with δLVEF (beta = −9.825, 95% CI −15.168 to −4.481, p < 0.0001), δLVEDD (beta = 4.879, 95% CI 1.725 to 8.069, p = 0.003), and δLVESD (beta = 5.079, 95% CI 1.421 to 8.738, p = 0.007). Conclusions In the present research, we demonstrated for the first time that SHR is significantly correlated with left ventricular negative remodelling after STEMI.

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Tension pneumothorax presenting as ST segment elevation: Look, Listen, Act!

Therapeutic Advances in Cardiovascular Disease ◽

10.1177/1753944717706922 ◽

2017 ◽

Vol 11 (7) ◽

pp. 195-197

Author(s):

Aditya Naraian Chada ◽

Naga Venkata Krishna Chand Pothineni ◽

Swathi Kovelamudi ◽

Deepa S. Raghavan

Keyword(s):

Myocardial Infarction ◽

Critical Care ◽

Physical Examination ◽

Tension Pneumothorax ◽

Unique Case ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Electrocardiogram Ecg ◽

Electrocardiographic Abnormalities

We present a unique case of a patient with a tension pneumothorax that presented with electrocardiogram (ECG) characteristics typical for ST segment elevation myocardial infarction. The clinical diagnosis was clinched by focused physical examination. Treatment of the pneumothorax lead to resolution of the electrocardiographic abnormalities. Our experience from this unique case is useful for cardiologists and critical care physicians who encounter these patients routinely.

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