ST Segment Elevation on Electrocardiogram: The Electrocardiographic Pattern of Brugada Syndrome

Ali A. Sovari, MD; Marilyn A. Prasun, RN, PhD; Abraham G. Kocheril, MD, FAC C, FACP

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Case Presentation

A 77-year-old white female patient was brought to the ED after becoming hypotensive and feeling lightheaded at home. The paramedics reported smelling natural gas at her home upon their arrival. Her blood pressure was 69/45 mm Hg and her oxygen saturation was 75% on room air. She was given 1 L of normal saline intravenously and 2 L/min O2 by nasal cannula, and her blood pressure and O2 saturation improved to 117/62 mm Hg and 95%, respectively. Her temperature was 97.1 °F, pulse rate 88 beats per minute, and her respiratory rate was 16 breaths per minute. She did not have any chest pain or palpitation. Her list of medications included triamterene/hydrochlorothiazide, lisinopril, aspirin, metformin, gemfibrozil, and supplemental vitamins for treatment of her hypertension, diabetes, hypercholesterolemia, and a history of transient ischemic attack. Physical examination was unremarkable for any cardiopulmonary abnormality or any pertinent findings.

Her electrocardiogram (Fig. 1) showed significant ST segment elevation in leads V1 to V4. Serial cardiac enzymes and troponin were within normal limits. Cardiac catheterization did not show any significant coronary artery stenosis. Her initial ECG met the criteria of type 1 Brugada syndrome and her follow-up ECG became normal.

The patient's electrocardiogram showed a J point elevation with a downsloping ST segment in V1 to V3, associated T wave inversion, absence of reciprocal ST depression, and pseudo-right bundle branch block pattern, which are typical features of type 1 Brugada pattern.

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