Abstract
Background:Brugada phenocopies are clinical entities etiologically distinct from congenital Brugada syndrome; differentiation is crucial for management.Case:A 29 year-old male with a history of cocaine abuse, brought in by Emergency Medical Services (EMS) after he was found unresponsive and given naloxone. He was found altered but arousable with verbal stimuli. He reported snorting a white powder to get “high”. He denied family history of sudden death or previous history of syncope. His ECG on presentation showed coved, ≥2 mm ST elevation with T-wave inversion in V2 consistent with Brugada EKG pattern (Figure 1). His troponin was trending up with elevated creatinine 1.6 mg/dl, liver enzymes and lactic acid, and urine toxicology was positive for cocaine.Decision-making:The presentation of altered mental status is multifactorial: metabolic derangement, drugs misuse and Brugada. Finding Brugada EKG pattern should be investigated to differentiate congenital Brugada syndrome and Brugada phenocopies. This patient has no family history of sudden death and no prior history of syncope. Serial EKG showed a gradual resolution of the coved and ST elevation in V2.Conclusion:our case demonstrates the importance of careful history taking including family history, as well as serial ECGs and treating the possible underlying etiology such as drugs abuse or electrolytes abnormality. It is also warranted to differentiate between Brugada phenocopies from congenital Brugada syndrome because therapeutic strategies are quite different with each diagnosis.
Highlights
Brugada electrocardiographic findings represent a distinct ECG pattern in leads V1-V3 with three different types [1]
When Brugada electrocardiographic pattern is present, itshould be investigated to differentiate congenital Brugada syndrome and Brugada phenocopies which defined as clinical conditions associated with Brugada electrocardiographic pattern caused by other factors including myocardial ischemia and metabolic derangements such as hypokalemia; and normalizes after resolution of the associated condition [2]
Brugada electrocardiographic pattern is a distinct ECG pattern in leads V1-V3 with three types: type I is characterized by coved ST-segment elevation that is ≥ 2 mm followed by a down-sloping concave with a negative symmetric T-wave, type II is defined as saddle-back convex ST segment elevation with variable T wave in V1, and type III is similar to type II but with positive or flat T wave in lead V2 [1]
Summary
Brugada electrocardiographic findings represent a distinct ECG pattern in leads V1-V3 with three different types [1]. When Brugada electrocardiographic pattern is present, itshould be investigated to differentiate congenital Brugada syndrome and Brugada phenocopies which defined as clinical conditions associated with Brugada electrocardiographic pattern caused by other factors including myocardial ischemia and metabolic derangements such as hypokalemia; and normalizes after resolution of the associated condition [2]. Differentiation Brugada phenocopies from congenital Brugada syndrome is crucial as the management is different. We presented a case of young male with history of recent cocaine use presented with altered mental status and found to have Brugada electrocardiographic pattern type I
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