Workup for Suspected Brugada Syndrome: Two Case Reports for the General Practitioner

Area of Science:

• Cardiology
• Genetics
• Electrocardiography

Background:

• ST-segment elevation on EKG typically suggests myocardial ischemia but can indicate other conditions like pericarditis, channelopathies, and genetic disorders.
• Primary care providers (PCPs) face challenges in diagnosing and managing these ST-segment elevation abnormalities.
• Brugada syndrome, a genetic channelopathy, is a critical consideration in young males presenting with ST-segment elevation, especially with minimal ischemic risk factors.

Observation:

• Two clinical cases of young males with anteroseptal ST-segment elevation, initially suspicious for Brugada syndrome, are presented.
• Case 1: A 23-year-old male with chest pain and palpitations showed EKG ST elevation; a procainamide challenge ruled out Brugada syndrome.
• Case 2: A 33-year-old male with incidental EKG ST elevation underwent a procainamide challenge revealing anterolateral ST changes; he was asymptomatic and advised on medication avoidance and fever management.

Findings:

• Risk stratification and management of Brugada syndrome require careful evaluation of symptoms, tachyarrhythmia history, and EKG findings.
• Procainamide challenge is a key diagnostic tool, with results guiding further patient management.
• Genetic testing may be indicated in suspected cases.

Implications:

• Maintaining a high index of suspicion for Brugada syndrome in young patients with unexplained ST-segment elevation is crucial for PCPs.
• A guideline-directed algorithmic workup can assist PCPs in evaluating suspicious cases.
• Accurate risk stratification enables appropriate management, including avoiding certain medications and considering genetic counseling.