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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