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Brugada phenocopy in concomitant ethanol and heroin overdose
Mehdi Rambod1, Sherif Elhanafi, Debabrata Mukherjee
1Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, Texas.
Summary
Heroin overdose can mimic Brugada syndrome, causing a Brugada phenocopy. Prompt treatment with naloxone resolved the ECG changes and symptoms in a patient with opioid and alcohol intoxication.
Area of Science:
- Cardiology
- Toxicology
- Emergency Medicine
Background:
- Brugada phenocopy refers to an electrocardiogram (ECG) pattern resembling Brugada syndrome, but without the underlying genetic condition.
- Distinguishing phenocopy from true Brugada syndrome is crucial for appropriate patient management and risk stratification.
Observation:
- A 44-year-old male presented with syncope and was found to have a Brugada type 1 ECG pattern.
- Toxicology revealed opiate and high serum alcohol levels.
- Continuous naloxone infusion was administered for suspected opioid toxicity.
Findings:
- The Brugada type 1 ECG pattern resolved within hours of naloxone treatment and supportive care.
- The patient regained consciousness and admitted to heroin abuse and alcohol consumption.
- This clinical course suggests heroin overdose as a precipitating factor for the Brugada phenocopy.
Implications:
- This case underscores the importance of considering toxicological agents, specifically heroin overdose, in the differential diagnosis of Brugada phenocopy.
- Recognition of drug-induced Brugada phenocopy can prevent misdiagnosis of congenital Brugada syndrome and guide appropriate, timely treatment.
- Further research into the electrophysiological effects of opioids and alcohol may elucidate mechanisms underlying Brugada phenocopy.