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Brugada syndrome-like ST-segment elevation increase exacerbated by vomiting.
Mariko Arai1, Kiyoshi Nakazawa, Akihiko Takagi
1Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
Summary
This case study highlights Brugada syndrome, a heart condition causing syncope. Nausea and vomiting-induced vagal stimulation temporarily altered ECG readings, mimicking Brugada syndrome patterns.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Brugada syndrome is an inherited cardiac arrhythmia characterized by specific ECG abnormalities and an increased risk of sudden cardiac death.
- Syncope, or fainting, can be a symptom of underlying cardiac conditions like Brugada syndrome.
Observation:
- A 53-year-old male presented with recurrent syncope.
- Electrophysiological studies repeatedly induced ventricular fibrillation (VF), suggesting Brugada syndrome.
- Administration of pilsicainide caused initial J-point and ST-segment elevation.
Findings:
- The patient experienced severe nausea and vomiting, leading to further J-point and ST-segment elevation on ECG.
- These ECG changes, potentially linked to vagal stimulation during nausea/vomiting, resolved within 30 minutes.
- The syncope was strongly suspected to be related to VF associated with Brugada syndrome.
Implications:
- This case illustrates a unique presentation of Brugada syndrome where vagal stimulation can transiently exacerbate ECG abnormalities.
- Understanding these transient changes is crucial for accurate diagnosis and management of Brugada syndrome.
- Further research into the interplay between vagal tone and Brugada syndrome pathophysiology is warranted.