Collapse in young patient with no cardicac history
CLINICAL HISTORY: 38 male, normally fit and well with no personal or family history of cardiac disease, presenting to ED after episode of collapse. Feeling nauseated and lightheaded while discussing knee surgery. No chest pain during the episode no palpitations. on examination soft systolic murmur on the aortic area, no alteration to the BP or pulses. ECG on arrival showed Bigeminy ( no previous to compare). ECG strip was obtained showing coved ST elevation in V1 V2 V3 V4
MISLEADING ELEMENTS: no family history of cardiac disease or sudden death, no chest pain. ECG on arrival showing bigemini.
HELPFUL DETAILS: ECG strip with features sugestive of brugada, previous similar episode in the past in similar circumstances
DIFERENTIAL: New onset cardiac arrhythmia, cardiac collapse, vasovagal episode, Brugada syndrome
DIAGNOSIS: BRUGADA SYNDROME
EDUCATIONAL CLINICAL RELEVANCE: Brugada syndrome is not a common presentation but needs to be in your list of differential while reviewing young patients presenting with episodes of collapse and ECG changes simulating STEMI. In this particular patient troponin and CK were normal and he sustained a new collapse in the department while waiting for cardiology review, was admitted for further investigations including ECHO. PAtients presenting asymptomatic with brugada syndrome can be wrongly discharged with adequate follow up if the clinician doesn't have a high grade of suspicious and recognize the subtle ECG changes.
