Pathophysiology of Hyperkalemia Presenting as Brugada Pattern on Electrocardiogram (ECG)

Area of Science:

• Cardiology
• Internal Medicine
• Toxicology

Background:

• Brugada phenocopies (BrP) are reversible ECG changes mimicking Brugada syndrome, often linked to ion channel dysfunction or conduction delays.
• These ECG patterns normalize once the underlying condition resolves.

Observation:

• A 26-year-old male presented with heroin overdose, rhabdomyolysis, and acute kidney injury.
• He exhibited severe hyperkalemia (7.2 mmol/L) and Brugada-like ECG changes (leads V1-V2).

Findings:

• ECG abnormalities resolved following bicarbonate administration and potassium normalization.
• The patient's condition improved with supportive care, including rehydration and antibiotics for community-acquired pneumonia.

Implications:

• This case underscores the importance of recognizing BrP as a manifestation of common electrolyte disturbances, particularly hyperkalemia.
• Prompt identification and management of the underlying cause are crucial for resolving BrP and preventing adverse outcomes.