Abstract 15984: Toxic Twist: A Case of Bupropion Induced Brugada Syndrome

Abstract

Introduction: Brugada syndrome is an inherited sodium channel pathology typically diagnosed by ECG findings. The condition can also be triggered by electrolye imbalances, fever and medications. It can result in ventricular tachycardia or fibrillation which can lead to sudden cardiac death. Therefore, it is vital to recognize the Brugada pattern on ECG and identify the potential triggers. Case Presentation: 36-year-old woman with past medical history of depression and prior suicidal attempt presented to emergency department with altered mental status secondary to intentional overdose of bupropion. Vitals were HR 118 beats per minute, BP 160/95 mmHg, RR 14 and SpO2 100% on room air. Physical examination was significant for tachycardia and lethargy. Laboratory values were significant for K + :3.3 mEq/L , HCO3 - :20 mEq/L , anion gap: 15, lactic acid: 5.5 mmol/L, ABG pH: 7.3. ECG on admission showed sinus tachycardia with rate of 121 and prolonged QTc 488 ms. Patient was monitored with serial ECGs given concern for Qtc prolongation. Later in the hospital course, ECG showed coved ST segment elevation in V1-V2 followed by a negative T wave. Echocardiogram was without structural abnormalities with EF of 55-60%. ICD placement was not indicated given this condition was drug induced with type 1 Brugada pattern and there was no family or personal history of syncope, arrhythmia or sudden cardiac death. Patient’s medication regimen was optimized with discontinuation of bupropion which was contraindicated in Brugada syndrome and avoidance of medications with sodium channel blocking effects was emphasized. Discussion: Brugada syndrome is a rare but potentially fatal condition. It becomes more challenging diagnosis in the absence of personal or familial cardiac history. It is very important to consider medications as a possible trigger for the condition given the management differs from inherited type and it does not generally require ICD placement.