CASE 03 • FREE SAMPLE
A young man who fainted at night
A 32-year-old man has recurrent nocturnal syncope and a family history of sudden unexplained death.
Clinical questions
1. Interpret the ECG systematically.
2. What is the most likely ECG diagnosis?
3. What is the immediate clinical significance?
4. What should be done next?
1. Interpret the ECG systematically.
2. What is the most likely ECG diagnosis?
3. What is the immediate clinical significance?
4. What should be done next?
Type 1 Brugada ECG pattern
Systematic interpretation & clinical correlation
Coved ST-segment elevation of at least 2 mm in the right precordial leads, followed by a negative T wave, is the diagnostic type-1 Brugada ECG pattern when recorded in the appropriate leads and clinical setting. High V1–V2 placement can increase sensitivity. Distinguish true Brugada syndrome from phenocopies caused by ischaemia, electrolyte disturbance or drugs.
Coved ST-segment elevation of at least 2 mm in the right precordial leads, followed by a negative T wave, is the diagnostic type-1 Brugada ECG pattern when recorded in the appropriate leads and clinical setting. High V1–V2 placement can increase sensitivity. Distinguish true Brugada syndrome from phenocopies caused by ischaemia, electrolyte disturbance or drugs.
Immediate approach / management
Treat fever promptly and stop provoking sodium-channel-blocking drugs. Syncope suspected to be arrhythmic, documented VT/VF or aborted sudden death warrants urgent electrophysiology assessment; survivors of cardiac arrest generally require an ICD. Avoid relying on a type-2/3 pattern alone for diagnosis.
Treat fever promptly and stop provoking sodium-channel-blocking drugs. Syncope suspected to be arrhythmic, documented VT/VF or aborted sudden death warrants urgent electrophysiology assessment; survivors of cardiac arrest generally require an ICD. Avoid relying on a type-2/3 pattern alone for diagnosis.
High-yield ECG pearl
Fever can unmask a type-1 pattern and increase ventricular-arrhythmia risk; obtain an ECG during febrile episodes in known/suspected Brugada syndrome.
Fever can unmask a type-1 pattern and increase ventricular-arrhythmia risk; obtain an ECG during febrile episodes in known/suspected Brugada syndrome.
ECG source/licence: Wikimedia Commons file page.