Professional Documents
Culture Documents
Carly Thompson
MD CCFP
EM Resident
July 31, 2008
Overview
Long QT Syndrome
Preexcitation Syndrome
Commotio cordis
Brugada Syndrome
Importance of Brugada
Syndrome
Mortality rate up to 10% / year in
untreated patients with typical ECG
changes!
Importance of Brugada
Syndrome
Brugada
What is It?
Pseudo-RBBB
ST Elevation V1-V3
Normal
RBBB
QRS 120ms
Terminal R wave in V1 (RSR1)
Slurred S wave in I and V6
Brugada Syndrome
PseudoRBBB
(but no
slurred S
in V6)
ST
Elevation
V1-V3
T wave
inversion
= Brugada
Syndrom
e ECG
ST Patterns in Brugada
Syndrome
Type 1 Coved Type
J wave 2mm convex
ST segment descends
Inverted T wave
Type 2 Saddle back
J wave 2mm
ST segment 1mm
Upright or biphasic T
Type 3 Saddle back
J wave 2mm
ST segment <1mm
Positive T wave
3 Different Patterns
Feature
Type 1
Type 2
Type 3
J wave
2mm
2mm
2mm
T wave
Negative Positive or
biphasic
Coved
Saddlebac
k
Gradual Elevated
descent 1mm
ST-T
ST
Segment
Terminal
Portion
Positive
Saddlebac
k
Elevated
<1mm
Transient Nature
Epidemiology
Prevalence:
Japan 1.0%, Type 1 is common up to 0.16%
Finland 0.6%, Type 1 is rare
USA 0.4%
Gender:
Male (Up to 9x more common!)
Children
consider fever, syncope
Age
average age of diagnosis is 41
Pathogenesis
Genetics
Arrhythmias in Brugada
Syndrome
Ventricular
Arrhythmias
Fibrillation
More common!
Provoking Factors
Sodium Imbalances
Drugs: Cocaine
TCAs and Neuroleptics
in overdose
Sodium channel
blockers: procainamide
Electrolyte Imbalances:
Sodium, Calcium
Lithium
Drugs
B-blockers
Local anesthetics
Autonomic Tone
Fever
Night
Valsalva
Pacing
history
Abnormal ECG
Inducible VT or VF
Previous syncope
19% arrhythmia in 33 months
Previous
arrest
Diagnosis
Type 1 ECG changes +
Documented VF, VT
Family hx of sudden cardiac death
Family members with ECG changes
Inducible VT
Unexplained syncope probable VT/VF
Nocturnal agonal respiration
Type 2 and 3
Type 1 ECG induced with sodium channel blocker
And criteria above
Treatment
Quinidine
Less inducible VT
Amiodarone
For patients with frequent discharges
Implantable Cardioverter-Defibrillator
(ICD)
Only treatment with proven efficacy
Case 1
Hx
Presented to family MD, asymptomatic
No syncope
No family history of sudden cardiac death
PMHx
Htn, Hyperlipidemia
Case 1
Referred
to electrophysiology for
further testing, and possible ICD
implantation.
Case 2
29 year old male
Hx
Cocaine use
No personal or family hx of syncope,
sudden cardiac death
Case 2
ECG
Case 3
29 year old Female
Hx
Presented to the ER after 3 episodes of palpitations
over 3 days, and a feeling of impending doom
Hx of sudden cardiac death in uncle at age 45
No hx of syncope
PMHx
Healthy
Meds
No medications
Case 3
Cardiology
consult:
Patient was admitted to hospital
Procainamide challenge -> VT
ICD placed
Patient discharged home in stable
condition
Summary
Think
of Brugada syndrome in a
patient with palpitations or syncope!
Pseudo-RBBB
ST Elevation V1-V3
Family history of sudden cardiac death
Send
References
Questions?
Thanks for
listening!