Coved and Saddleback ST-Segment Elevations: Brugada Phenocopy vs Brugada Syndrome
Jocelyn McCullough1, Joseph McCullough2, Marcella Gonzalez2
1Medical Education, Zucker School of Medicine, Hempstead, USA.
Cureus
|May 24, 2022
Summary
A case of Brugada syndrome (BrS) was diagnosed in a man with fever and abnormal ECGs. Resolution of fever led to normal ECGs, differentiating BrS from Brugada phenocopy.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Brugada syndrome (BrS) is a genetic disorder characterized by abnormal electrocardiogram (ECG) findings and an increased risk of sudden cardiac death.
- Differentiating BrS from Brugada phenocopy (BrP), which mimics BrS ECG patterns due to reversible causes, is clinically significant.
Observation:
- A middle-aged man presented with syncope, fever, and dysuria, exhibiting type 1 Brugada ECG patterns.
- The ECG pattern transiently shifted to type 2 Brugada before returning to normal after fever resolution and antibiotic treatment for E. coli bacteremia and prostatitis.
Findings:
- The patient's dynamic ECG changes, including resolution of ST-segment abnormalities upon fever management, confirmed a diagnosis of Brugada syndrome.
- Absence of electrolyte abnormalities or confounding medications supported the diagnosis over a phenocopy.
Implications:
- This case highlights the importance of considering reversible causes, such as infections, in the differential diagnosis of Brugada ECG patterns.
- Continuous cardiac monitoring and observation for ECG pattern resolution are crucial for distinguishing Brugada syndrome from phenocopy.
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