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Brugada pattern masking anterior myocardial infarction
1Cardiology Department, National University Health System, 1E Kent Ridge Road, Level 9, NUHS Tower Block, Singapore 119228. swee_chong_seow@nuhs.edu.sg
Singapore Medical Journal
|September 28, 2011
Summary
Brugada syndrome can mask ST elevation myocardial infarction (STEMI) on electrocardiograms (ECGs), complicating diagnosis. This case highlights the challenge of differentiating these critical cardiac conditions.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Brugada syndrome is an inherited cardiac channelopathy associated with ventricular arrhythmias.
- ST-elevation myocardial infarction (STEMI) is a critical condition requiring rapid diagnosis and intervention.
Observation:
- A middle-aged male smoker presented with chest pain and an initial ECG showing a Brugada Type 1 pattern.
- Subsequent ECGs and elevated cardiac enzymes indicated an evolving anterior STEMI.
- Coronary angiography revealed significant left anterior descending artery stenoses requiring emergent stenting.
Findings:
- The Brugada Type 1 pattern on the initial ECG obscured the diagnostic ECG changes of STEMI.
- This ECG pattern presented a diagnostic challenge, potentially delaying STEMI recognition.
Implications:
- Clinicians must consider the possibility of co-existing Brugada syndrome and STEMI in patients with atypical presentations.
- Awareness of how Brugada patterns can mask STEMI is crucial for timely diagnosis and management of acute coronary syndromes.
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