Case Presentation: A 22-year-old male with a history of anti-neutrophil cytoplasmic antibody vasculitis, renal transplant, hypertension, and no known family history of sudden cardiac death suffered a witnessed cardiac arrest. An initial rhythm strip recorded by emergency medical services revealed ventricular fibrillation. Return of spontaneous circulation was achieved after three rounds of cardiopulmonary resuscitation, defibrillation, and intravenous epinephrine. The patient was brought to the emergency department and admitted to the intensive care unit. He was diagnosed with Brugada syndrome, and an automatic implantable cardioverter-defibrillator (AICD) was placed after discharge.
\nDiscussion: Brugada syndrome is characterized electrocardiographically by ≥2 millimeters (mm) ST-segment elevation in leads V1–V2 with either “coved type” (type 1) or “saddleback” (type 2) ST-segment morphology, or ≤2 mm ST-segment elevation in V1–V2 with either “coved” or “saddleback” morphology (type 3). The absence of these patterns on isolated electrocardiograms (ECG) does not exclude the diagnosis, as dynamic fluctuations in ECG patterns are well-documented and can be induced by various physiologic stressors. This case provides an uncommon, complete electrocardiographic history of Brugada syndrome, from out-of-hospital cardiac arrest to AICD placement and depicts dynamic fluctuations between Brugada patterns and normal ECGs. This highlights the importance of serial ECGs in diagnosis, as sudden cardiac death is often the first or only presentation of Brugada syndrome.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Brugada syndrome"},{"word":"sudden cardiac death"},{"word":"cardiac arrest"},{"word":"coved ST-segment elevation"},{"word":"saddle-back ST-segment elevation"}],"section":"Images in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5cj6g122","frozenauthors":[{"first_name":"Mark","middle_name":"L.","last_name":"Moubarek","name_suffix":"","institution":"University of California, Davis Health, Department of Emergency Medicine, Sacramento, California","department":""},{"first_name":"Gordon","middle_name":"X.","last_name":"Wong","name_suffix":"","institution":"University of California, Davis Health, Department of Internal Medicine, Division of Cardiovascular Medicine, Sacramento, California","department":""},{"first_name":"James","middle_name":"S.","last_name":"Ford","name_suffix":"","institution":"University of California, San Francisco, Department of Emergency Medicine, San Francisco, California","department":""}],"date_submitted":"2024-02-22T02:03:52.696000Z","date_accepted":"2024-05-03T14:55:28.734000Z","date_published":"2024-08-02T13:00:00Z","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/19477/galley/24597/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/19477/galley/10854/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/19477/galley/24597/download/"}]}