Medical Minute: Brugada Syndrome

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August 22, 2014 by dailybolusoflr

By: Marrissa Baker, MD

  • Autosomal dominant genetic disease of mutation in cardiac sodium channels (but no structural abnormality) which is characterized by abnormal ECG findings and increased risk of sudden death
  • Three ECG patterns with persistent ST elevations and RBBB pattern in V1-V3

  1. Type 1: “coved” ST-segment elevation > 2mm followed by a negative T wave
  2. Type 2: ST-segment elevation > 2mm with a “saddle back” ST-T wave configuration followed by a positive or biphasic T wave
  3. Type 3: ST segment elevation (coved, saddle-back, or both) not meeting criteria of Type 1 or 2

Mizusawa Y, Wilde A. Brugada Syndrome. Circ Arrhythm Electrophysiol. 2012. 5: 606-616.
  •  Moving the right precordial chest leads to the second or third intercostal space may increase the sensitivity of detecting abnormalities
  • More prevalent in males with average age of 41
  •  Mortality of 10% per year
  • 1/3 of patients present with syncope as first manifestation
  •   Associated Atrial fibrillation is a prevalent finding and palpitations may be the first symptom
  • May be triggered by fever or a number of drugs that can be found at www.brugadadrugs.org
  • Definitive treatment is ICD placement

  • To make diagnosis must have ECG pattern and 1 of the following clinical characteristics
o   history of VT/VF
o   family history of sudden cardiac death
o   family history of coved-type ECG
o   agonal respirations during sleep
o   inducible VT/VF during EP study

·   
References:
  1. Mizusawa Y, Wilde A. Brugada Syndrome. Circ Arrhythm Electrophysiol. 2012. 5: 606-616.
  2. Uptodate: Brugada syndrome
  3. http://lifeinthefastlane.com/what-is-brugada-syndrome/
  4. http://www.brugadadrugs.org

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