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Hyperkalemia and cocaine induced dynamic Brugada-type electrocardiogram
Farzan Irani1, Rahil Kasmani, Yousuf Kanjwal
1Department of Internal Medicine, St. Vincent Mercy Medical Center, University of Toledo Medical Center, Toledo, Ohio 43608, USA. farzan_i@yahoo.com
Summary
Cocaine abuse and hyperkalemia can trigger acquired Brugada sign, a specific electrocardiogram pattern. Prompt treatment with sodium bicarbonate resolved the Brugada sign in a patient with hyperkalemia.
Area of Science:
- Cardiology
- Clinical Electrophysiology
- Toxicology
Background:
- Brugada syndrome is characterized by specific ECG abnormalities in leads V1-V2, often linked to SCN5A gene mutations.
- A Brugada-like pattern can be induced by sodium channel blockers and electrolyte disturbances.
- Acquired Brugada sign necessitates identifying and managing reversible triggers.
Observation:
- A 46-year-old individual presented with hyperkalemia due to muscle damage and renal insufficiency following cocaine abuse.
- The patient's electrocardiogram (ECG) exhibited the characteristic Brugada sign.
- The ECG abnormalities resolved following sodium bicarbonate administration and correction of hyperkalemia.
Findings:
- Cocaine-induced hyperkalemia can precipitate an acquired Brugada sign.
- Sodium bicarbonate is effective in reversing cocaine- and hyperkalemia-induced Brugada sign.
- This case underscores the reversible nature of the acquired Brugada sign.
Implications:
- Clinicians should consider cocaine use and hyperkalemia in patients presenting with Brugada sign.
- Prompt recognition and management of these triggers can prevent potentially life-threatening arrhythmias.
- Understanding acquired Brugada sign broadens differential diagnoses for ECG abnormalities.
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