COVID-19: An Emerging Etiology for the Brugada Pattern on EKG

Abstract

Brugada syndrome is an inherited arrhythmogenic disorder characterized by autosomal dominant mutations in several identified genes encoding for cardiac voltage-gated sodium channels. The underlying mutations predispose individuals to ventricular tachycardia, ventricular fibrillation, and sudden cardiac death. Oftentimes, the condition is asymptomatic until a triggering event occurs, with sodium channel blockers, fever and alcohol being common risk factors for appearance of the Brugada pattern on EKG. COVID-19 diagnosis can also present a risk for Brugada presentation. COVID-19 is known to exacerbate other cardiac arrhythmias and channelopathies such as Long-QT syndrome, in addition to being known to cause fever and electrolyte imbalance. We present the case of a patient exhibiting the Brugada pattern on EKG with symptoms of chest tightness, shortness of breath, and tachycardia shortly after testing positive for COVID-19 in the Emergency Department. Due to the potential for unmasking the Brugada pattern as well as other cardiac arrhythmias during COVID-19 infection, patient and family history should be thoroughly considered to rule out potential genetic conditions when examining patients who test positive for SARS-CoV-2. This case is presented to highlight COVID-19 as a potential etiology of the Brugada pattern on EKG in genetically predisposed individuals.