Brugada Phenocopy Research Articles

Electrocardiogram (ECG) changes of a patient with severe hyperkalemia

A 55-year-old gentleman with underlying type 2 diabetes mellitus, dyslipidemia, hypertension, and end stage renal disease presented with shortness of breath, vomiting and worsening fatigue for one day after missing his scheduled hemodialysis. Physical examination in revealed tachypnoea with a respiratory rate of 30 breaths per minute, and fine mid inspiratory crepitations at the lung bases. Initial blood investigations in the emergency department revealed severe metabolic acidosis and hyperkalemia with a potassium of 7.6 mmol/L. A 12 lead electrocardiogram was done and several features that suggest hyperkalemia were detected such as a narrow based and symmetrical tall, tented T wave. In V1 the QRS complex is reminiscent of Brugada type 1 which is probably Brugada phenocopy and are often seen in hyperkalemia. There is ST elevation in V2, a single precordial lead. There is no reciprocal ST depression, and a lone ST elevation does not indicate ischemia. This may be caused by hyperkalemia as well. There is a broad QRS of 136ms, widened QRS is characteristic of hyperkalemia. There is a broad P wave and the PR interval is approximately 200ms. Left ventricular hypertrophy is also present. Due to impending respiratory collapse, he was subsequently intubated. His hyperkalemia was treated with intravenous short acting human insulin, dextrose 50%, calcium gluconate, sodium bicarbonate and calcium polystyrene sulfonate. He was subsequently admitted to the intensive care unit (ICU) and had undergone emergency hemodialysis.

Brugada phenocopy unmasked during a febrile illness.

Ceylon Medical Journal (CMJ) is a peer-reviewed, open access journal published quarterly by the Sri Lanka Medical Association in the last week of March, June, September and December each year. The mission of the CMJ is to promote the science and art of medicine and betterment of public health. The Journal publishes original papers and commentaries which have relevance to medicine and allied sciences. The CMJ is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.

A Rare Case of Brugada Phenocopy in A Patient With Takotsubo Cardiomyopathy Masquerading as an Acute Coronary Syndrome

Brugada phenocopies (BrP) are clinical entities that are etiologically distinct from true congenital Brugada syndrome. BrP are characterized by type 1 or 2 Brugada electrocardiogram (ECG) patterns in precordial leads V1-V3. However, BrP is elicited by various underlying clinical conditions such as myocardial ischemia, pulmonary embolism, electrolyte abnormalities, or poor ECG filters. Upon resolution of the inciting underlying pathological condition, the BrP ECG subsequently normalizes. Takotsubo (octopus fishing pot) cardiomyopathy (TCM) also known as stress cardiomyopathy is an acute cardiac condition characterized by transient systolic dysfunction of the left ventricular apex and mid-ventricle with depressed LV function mimicking acute coronary syndrome (ACS) and recovers within a few weeks. TCM is most commonly seen in postmenopausal women with intense physical and or emotional stress. We are reporting a rare case of BrP in a patient with TCM masquerading as ACS posing a diagnostic and therapeutic challenge.

Brugada phenocopy induced by consumption of yellow oleander seeds – A case report

Brugada phenocopy is a brugada-like pattern in ECG seen in some diseases without an inherited channelopathy. The causes of brugada phenocopy are usually reversible. Once the reversible condition resolves, the ECG pattern disappears. There are many conditions that cause brugada phenocopy like myocardial infarction, hyperkalemia etc. Here we report a case of brugada phenocopy induced by consumption of yellow oleander seeds (T. Peruviana).

Brugada phenocopy following coronary artery bypass graft surgery

A 71-year old male with a history of inferior myocardial infarction and hypertension underwent coronary artery bypass graft (CABG) surgery. He had no family or personal history of syncope, sudden cardiac death or Brugada syndrome. A series of twelve-lead electrocardiograms showed type 1 and type 2 Brugada ECG patterns after procedure, but resolution of ST segment changes to five days later. The electrophysiological mechanisms underlying these changes will be discussed.

Brugada Phenocopy Induced by a Lethal Methanol Intoxication.

Brugada phenocopies (BrP) are clinical entities that present with an ECG pattern identical to either the type 1 or type 2 Brugada pattern without true congenital Brugada syndrome. This ECG pattern is associated with an identifiable condition and normalizes upon resolution or treatment of the underlying cause. We present a case of a 54-year-old man with extreme metabolic acidosis, hyperkalaemia and a Brugada type 1 ECG pattern in the setting of a suicidal methanol (MeOH) poisoning. Upon correction of these metabolic derangements with bicarbonate infusions and continuous veno-venous haemodiafiltration (CVVH), the Brugada type 1 ECG pattern normalized. Unfortunately, the patient developed signs of cerebral herniation followed by brain death and died on the first day of ICU admission.LEARNING POINTSBrugada-like ECG patterns are described in several metabolic conditions such as extreme hyperglycaemia, glucose/insulin challenge, isolated hyperkalaemia or in association with hyponatraemia and acidosis.Until now, there have been no published case reports of BrP in association with methanol intoxication.Correction of hyperkalaemia and acidosis and specific therapy for methanol intoxication leads to a complete resolution of a Brugada type 1 ECG pattern.

Brugada Syndrome or Phenocopy? Diagnostic Challenge in Patients with Pectus Excavatum

Brugada syndrome is an autosomal dominant heart disease caused by dysfunctions in the ionic channels, whose carriers present a classic electrocardiographic pattern and predisposition to malignant ventricular arrhythmias. The electrocardiogram alterations may be dynamic, spontaneous, or induced by sodium channel blocking drugs (ajmaline, procainamide, etc.). However, electrocardiographic findings that diagnose Brugada syndrome may occur even in the absence of congenital dysfunction of ionic channels, characterizing “Brugada phenocopy”, therefore the exclusion of secondary causes is fundamental for the correct diagnosis of channelopathy.

Brugada phenocopies: Current evidence, diagnostic algorithms and a perspective for the future.

Brugada syndrome (BrS) is a congenital channelopathy associated with the development of malignant ventricular arrhythmias and sudden cardiac death. The diagnosis of BrS is made based on Brugada ECG pattern and clinical history. Brugada phenocopies (BrP) are clinical entities that are characterized by ECG patterns identical to those of BrS but arise from different underlying conditions such as metabolic abnormalities, myocardial ischemia and mechanical compression. Distinction between the two is important because BrS requires investigations for risk stratification whereas BrP requires appropriate treatment for the underlying conditions. In the present review, we summarized the current data in the literature, systematic diagnostic approach, gaps in the literature and future perspective on BrP.

Transient Brugada-like ECG pattern incited by uncontrolled hypertension - a rare case report

Background: Brugada syndrome (BrS) is a rare form of channelopathy caused by mutation of SCN5A gene that encodes for sodium channel and is associated with increased risk of ventricular arrhythmia and sudden cardiac death. BrS has a characteristic electrocardiographic (ECG) pattern. Various stressors can induce Brugada-like patern on ECG in the absence of BrS known as Brugada phenotype. Case Presentation: We report a case of a 28-year-old African-American male patient who presented to the emergency department with a chief complaint of atypical chest pain. He was noted to have an elevated blood pressure and a type 1 Brugada patern on his 12-lead ECG. His ECG changed from type 1 to type 3 Brugada patern upon controlling blood pressure, which indicated the presence of a Brugada phenocopy. Conclusion: It is important to recognize the underlying stressors that can lead to Brugada-like patterns on the ECG since these stressors are treatable without any sequel.

Link between Brugada phenocopy and myocardial ischemia: Results from the International Registry on Brugada Phenocopy.

Brugada phenocopies clinical entities that have indistinguishable electrocardiographic (ECG) patterns from true congenital Brugada syndrome. However, they are induced by other clinical circumstances such as myocardial ischemia. The purpose of our study was to examine the clinical features and pathogenesis of ischemia-induced Brugada phenocopy (BrP). Data from 17 cases of ischemia-induced BrP were collected from the International Registry (www.brugadaphenocopy.com). Data were extracted from these publications and authors were contacted to provide further insight into each case. Of the patients included in this study, 71% were male. Mean age was 59 ± 11 years (range: 38-76). Type-1 Brugada ECG pattern occurred in 15/17 (88%) of the cases, while a type-2 Brugada ECG pattern was observed in the other 2/17 (12%). In all cases, the Brugada ECG pattern resolved upon correction of the ischemia, indicating ischemia as the inducing circumstance. No arrhythmic events have been detected acutely or during the follow-up. Reported time to resolution ranged from 2 minutes to 5hours. Provocative challenges using sodium channel blocking agents were performed in 7/17 cases (41%), and all failed to induce a Brugada ECG pattern (BrP Class A). The remaining 10/17 cases (59%) did not undergo provocative testing due to various clinical reasons. Myocardial ischemia is a commonly reported etiology of BrP. Importantly, this study found no association between BrP induced by myocardial ischemia and sudden cardiac death or malignant ventricular arrhythmias.

BRUGADA PHENOCOPY UNMASKED AFTER A MOTOR VEHICLE ACCIDENT

The electrocardiographic (ECG) pattern of Brugada syndrome (BrS) has characteristic findings and is associated with fatal ventricular arrhythmias. Brugada phenocopy (BrP) ECG findings are identical to the syndrome but are elicited by certain clinical circumstances. A 56 year old Caucasian female

Signal-averaged Electrocardiograph Can Evaluate Citrate Response and Vasovagal Reflex During Apheresis Donation

We herein describe a case of an acute pericarditis, in which type 1 Brugada phenocopy (BrP) was documented. The patient was referred to our hospital due to severe chest pain. The twelve-lead electrocardiogram (ECG) on admission showed type 1 Brugada ECG pattern (coved-type) in the precordial leads. Echocardiography only showed mild pericardial effusion. However, his ST segment elevation returned to normal and chest discomfort disappeared 3 weeks later. Our report addresses the possibility that the coved-type ST-segment elevation cannot be a sensitive finding for Brugada syndrome (BrS). Detailed tests are anyway needed to make appropriate diagnostic and therapeutic decisions.

Evaluation of the mortality in patients with atrial fibrillation in a large electronic cohort: Clinical Outcomes in Digital Electrocardiography (CODE) study

We herein describe a case of an acute pericarditis, in which type 1 Brugada phenocopy (BrP) was documented. The patient was referred to our hospital due to severe chest pain. The twelve-lead electrocardiogram (ECG) on admission showed type 1 Brugada ECG pattern (coved-type) in the precordial leads. Echocardiography only showed mild pericardial effusion. However, his ST segment elevation returned to normal and chest discomfort disappeared 3 weeks later. Our report addresses the possibility that the coved-type ST-segment elevation cannot be a sensitive finding for Brugada syndrome (BrS). Detailed tests are anyway needed to make appropriate diagnostic and therapeutic decisions.

Lower 24-hour Holter-Derived Heart Rates Suggest Brugada Syndrome: Study of the Family

We herein describe a case of an acute pericarditis, in which type 1 Brugada phenocopy (BrP) was documented. The patient was referred to our hospital due to severe chest pain. The twelve-lead electrocardiogram (ECG) on admission showed type 1 Brugada ECG pattern (coved-type) in the precordial leads. Echocardiography only showed mild pericardial effusion. However, his ST segment elevation returned to normal and chest discomfort disappeared 3 weeks later. Our report addresses the possibility that the coved-type ST-segment elevation cannot be a sensitive finding for Brugada syndrome (BrS). Detailed tests are anyway needed to make appropriate diagnostic and therapeutic decisions.

The combined evaluation of ambulatory-based late potentials and heart rate turbulence to predict ventricular arrhythmias in patients with postmyocardial infarction

Brugada phenocopies (BrP) are clinical entities that are characterized by ECG patterns identical to those of Brugada syndrome, but are the result of various clinical conditions. We describe the case of a 41-year-old male who exhibited BrP due to a left ventricular aneurysm in the context of chronic coronary artery disease.

The changes of QT interval in standing position – new criteria for diagnostic syndrome (LQTS)

We herein describe a case of an acute pericarditis, in which type 1 Brugada phenocopy (BrP) was documented. The patient was referred to our hospital due to severe chest pain. The twelve-lead electrocardiogram (ECG) on admission showed type 1 Brugada ECG pattern (coved-type) in the precordial leads. Echocardiography only showed mild pericardial effusion. However, his ST segment elevation returned to normal and chest discomfort disappeared 3 weeks later. Our report addresses the possibility that the coved-type ST-segment elevation cannot be a sensitive finding for Brugada syndrome (BrS). Detailed tests are anyway needed to make appropriate diagnostic and therapeutic decisions.

Mutational Spectrum of the SCN5A gene in Brugada Syndrome Patients

We herein describe a case of an acute pericarditis, in which type 1 Brugada phenocopy (BrP) was documented. The patient was referred to our hospital due to severe chest pain. The twelve-lead electrocardiogram (ECG) on admission showed type 1 Brugada ECG pattern (coved-type) in the precordial leads. Echocardiography only showed mild pericardial effusion. However, his ST segment elevation returned to normal and chest discomfort disappeared 3 weeks later. Our report addresses the possibility that the coved-type ST-segment elevation cannot be a sensitive finding for Brugada syndrome (BrS). Detailed tests are anyway needed to make appropriate diagnostic and therapeutic decisions.

Short Term Cardiac Monitoring of Patients with Severe Sleep Apnea does not Allow for the Prediction of Atrial Fibrillation

Brugada phenocopies (BrP) are clinical entities that are characterized by ECG patterns identical to those of Brugada syndrome, but are the result of various clinical conditions. We describe the case of a 41-year-old male who exhibited BrP due to a left ventricular aneurysm in the context of chronic coronary artery disease.

Arrhythmogenecity of Right Ventricular Outflow Tract Epicardium -A Simulation Study

We herein describe a case of an acute pericarditis, in which type 1 Brugada phenocopy (BrP) was documented. The patient was referred to our hospital due to severe chest pain. The twelve-lead electrocardiogram (ECG) on admission showed type 1 Brugada ECG pattern (coved-type) in the precordial leads. Echocardiography only showed mild pericardial effusion. However, his ST segment elevation returned to normal and chest discomfort disappeared 3 weeks later. Our report addresses the possibility that the coved-type ST-segment elevation cannot be a sensitive finding for Brugada syndrome (BrS). Detailed tests are anyway needed to make appropriate diagnostic and therapeutic decisions.

Model Interpretation of BSPM Based SCD Risk Markers

Brugada phenocopies (BrP) are clinical entities that are characterized by ECG patterns identical to those of Brugada syndrome, but are the result of various clinical conditions. We describe the case of a 41-year-old male who exhibited BrP due to a left ventricular aneurysm in the context of chronic coronary artery disease.