Syncopal Episodes in Coved ST-Segment Elevation and T-Wave Inversion in Anterior Leads

Area of Science:

• Cardiology
• Electrophysiology
• Internal Medicine

Background:

• Syncope is a common clinical presentation, particularly in the elderly.
• Brugada syndrome is a rare genetic disorder characterized by specific electrocardiogram abnormalities and an increased risk of sudden cardiac death.
• The typical onset of Brugada syndrome is in younger to middle-aged adults, making late-onset presentation uncommon.

Purpose of the Study:

• To describe a unique case of Brugada syndrome presenting in an 88-year-old male.
• To emphasize the importance of investigating syncopal episodes with suggestive electrocardiographic findings, even in older individuals.
• To discuss the diagnostic challenges and differential diagnoses associated with late-onset Brugada syndrome.

Main Methods:

• Case report of an 88-year-old male with recurrent syncopal episodes.
• Clinical assessment including physical examination and vital signs.
• Standard 12-lead electrocardiogram (ECG) analysis revealing characteristic abnormalities.
• Discussion of differential diagnoses and ECG pattern evolution.

Main Results:

• The patient presented with recurrent syncope, often preceded by palpitations.
• Electrocardiogram showed normal sinus rhythm with coved ST-segment elevation and T-wave inversion in anterior leads, suggestive of Brugada syndrome.
• No significant findings were detected during physical examination, and the patient was asymptomatic at the time of assessment.

Conclusions:

• Electrocardiographic abnormalities suggestive of Brugada syndrome warrant thorough investigation, including advanced cardiac imaging, in patients with syncope.
• Rare structural cardiac pathologies should be excluded, especially in elderly patients.
• Late-onset Brugada syndrome, while uncommon, should be considered in the differential diagnosis of syncope in older populations.