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

We describe the case of an 88-year-old male patient referred to our cardiology outpatient clinic because of recent and recurrent syncopal episodes, often preceded by palpitations. At clinical assessment, the patient was asymptomatic, vital signs were normal, and no relevant findings at physical examination were detected. The standard 12-lead electrocardiogram showed a normal sinus rhythm with coved ST-segment elevation and T-wave inversion in anterior leads. A differential diagnosis is discussed, and the evolution of the electrocardiographic pattern throughout the course of the disease is also described.

The detection of electrocardiographic abnormalities highly suggestive of Brugada syndrome in patients with syncopal episodes always deserves careful investigation (including multimodality cardiac imaging) to exclude even rare structural cardiac pathologies, especially in older patients in whom the onset of Brugada syndrome is definitely uncommon.