ST segment elevation on electrocardiogram: the electrocardiographic pattern of Brugada syndrome

A 77-year-old white diabetic woman was brought to our emergency department (ED) after becoming lightheaded and hypotensive at home. Her routine tests including a chest radiograph were normal. Her electrocardiogram (ECG) showed significant ST segment elevation in leads V1 to V4. Serial cardiac enzymes and troponin were within normal limits. Her ECG met the criteria for type 1 Brugada syndrome. Brugada syndrome, which is more common in young Asian males, is an arrhythmogenic disease caused in part by mutations in the cardiac sodium channel gene SCN5A. To diagnose the Brugada syndrome, 1 ECG criterion and 1 clinical criterion should exist. Brugada syndrome can be associated with ventricular tachycardia or fibrillation; the only treatment proven to prevent sudden death is placement of an implantable cardioverter defibrillator, which is recommended in symptomatic patients or in those with ventricular tachycardia induced during electrophysiologic studies and a type 1 ECG pattern of Brugada syndrome. It is important to recognize the Brugada ECG pattern and to differentiate it from other etiologies of ST segment elevation on ECG.