Brugada Alarms
Report:
Sinus rhythm 70/min
Borderline left atrial abnormality
Anteroseptal ST segment elevation
Comment:
The patient presented to Casualty following a syncopal attack and his ECG, especially in lead V2, showed a saddleback-type (type 2) ST segment elevation consistent with Brugada syndrome23. This morphology can be transformed to coved (type 1) elevation by drugs such as ajmaline or procainamide; this would make the diagnosis of Brugada syndrome quite likely. It did not happen in his case.
The syncope itself sounded like a common or garden variety of vaso-vagal syncope and the patient was eventually reassured and sent home.
Interesting presentations often “fizzle”; we all like the zebras. Most subjects with type 2 Brugada sign on their ECGs have in fact no more than normal variants, as shown in a Finnish population study24.
The syndrome has been recently reviewed; the illustration on the right is borrowed from a consensus article25.
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