Type 1 Brugada Pattern Associated with Nicotine Toxicity

Area of Science:

• Cardiology
• Toxicology
• Emergency Medicine

Background:

• Brugada syndrome (BrS) is a genetic disorder associated with sudden cardiac death.
• Brugada pattern (BrP) on electrocardiogram (ECG) is essential for diagnosing BrS.
• The underlying mechanisms of BrS and its triggers are not fully understood.

Observation:

• A young woman using topical nicotine for smoking cessation presented with symptoms of mild nicotine toxicity.
• Her ECG revealed a type 1 Brugada pattern (BrP).
• Subsequent ECGs normalized, and electrophysiology consultation was obtained.

Findings:

• This case represents the first reported instance of a Brugada pattern (BrP) associated with nicotine toxicity.
• Nicotine, particularly at high doses, may act as a potential trigger for transient ECG abnormalities.
• The transient nature of ECG changes necessitates careful monitoring and vigilance.

Implications:

• Emergency physicians must be aware of the potential for transient ECG abnormalities like BrP.
• Prompt recognition of BrP is crucial for diagnosing BrS and preventing sudden cardiac death.
• Understanding potential environmental triggers like nicotine toxicity is vital for patient management and risk stratification.