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Brugada syndrome with elevated cardiac biomarkers
Fatima AlKendi1, Mujgan Jamil, Anwer Qureshi
1Division of Medicine, Department of Medicine, Tawam Hospital, Al Ain, United Arab Emirates.
BMJ Case Reports
|July 2, 2013
Summary
This case highlights a Brugada syndrome diagnosis in a patient presenting with chest pain and palpitations. Ajmaline testing confirmed the condition, differentiating it from acute myocardial infarction.
Area of Science:
- Cardiology
- Clinical Electrophysiology
Background:
- Brugada syndrome is a rare genetic disorder affecting the heart's electrical system.
- It is characterized by specific ECG abnormalities and an increased risk of sudden cardiac death.
Observation:
- A 45-year-old male presented with palpitations, presyncope, and chest pain.
- ECG revealed a type 2 Brugada pattern (rsr' in V1, saddle-back ST elevation in V2).
- Telemetry showed asymptomatic non-sustained polymorphic ventricular tachycardia.
Findings:
- Ajmaline challenge test confirmed Brugada syndrome.
- Cardiac biomarkers suggested myocardial infarction, but coronary angiography showed normal coronaries.
- Echocardiogram revealed normal cardiac structure and function, ruling out myopericarditis.
Implications:
- This case underscores the importance of recognizing Brugada ECG patterns in patients with concerning symptoms.
- Differentiating Brugada syndrome from acute coronary syndromes is crucial for appropriate management.
- The case highlights the utility of ajmaline challenge testing for diagnosis.
- Management decisions, including the recommendation for an automated intracardiac defibrillator, require careful consideration of patient factors and preferences.
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