brugada syndrome ecg
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Brugada SyndromeBrugada SyndromeCarly ThompsonCarly Thompson
MD CCFPMD CCFPEM ResidentEM Resident
July 31, !!"July 31, !!"
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#$er$ie%#$er$ie%
&mportan'e o( Brugada Syndrome&mportan'e o( Brugada Syndrome EC) Changes in Brugada SyndromeEC) Changes in Brugada Syndrome EpidemiologyEpidemiology PathogenesisPathogenesis DiagnosisDiagnosisTreatmentTreatment
EC) Pra'ti'eEC) Pra'ti'e
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Sudden Cardia' *rrestSudden Cardia' *rrest
Cardia' *rrest in a Stru'turally +ormalCardia' *rrest in a Stru'turally +ormal
earteart
- .ong /T Syndrome.ong /T Syndrome
- Pree0'itation SyndromePree0'itation Syndrome
- Commotio 'ordisCommotio 'ordis
- Brugada SyndromeBrugada Syndrome
http://www.imageenvision.com/stock_clipart/details/0025-0802-2610-2956/red_love_heart_cartoon_character_dressed_as_a_super_hero -
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&mportan'e o( Brugada&mportan'e o( Brugada
SyndromeSyndrome
Mortality rate up to 1! 2 year inMortality rate up to 1! 2 year in
untreated patients %ith typi'al EC)untreated patients %ith typi'al EC)
'hanges'hanges
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&mportan'e o( Brugada&mportan'e o( Brugada
SyndromeSyndrome
Brugada syndrome 'an 4e identi5edBrugada syndrome 'an 4e identi5ed
4y EC) and su''ess(ully treated 4y4y EC) and su''ess(ully treated 4y
&CD&CD
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Brugada Syndrome6 EC)Brugada Syndrome6 EC)
ChangesChanges
First des'ri4ed in 177 4y J 8 PFirst des'ri4ed in 177 4y J 8 P
BrugadaBrugada
9hat is &t:9hat is &t: Pseudo;RBBBPseudo;RBBB
ST Ele$ation
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+ormal $s RBBB $s Brugada+ormal $s RBBB $s Brugada
SyndromeSyndrome
+ormal+ormal
RBBBRBBB
- /RS/RS ==1!ms1!ms
- Terminal R %a$e in RSRTerminal R %a$e in RSR11??
- Slurred S %a$e in & and
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Pseudo;Pseudo;
RBBBRBBB
>4ut no>4ut no
slurred Sslurred Sin
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ST Patterns in BrugadaST Patterns in Brugada
SyndromeSyndrome
Type 1 Co$ed TypeType 1 Co$ed Type J %a$eJ %a$e = mm 'on$e0= mm 'on$e0 ST segment des'endsST segment des'ends &n$erted T %a$e&n$erted T %a$e
Type Saddle 4a'Type Saddle 4a' J %a$e = mmJ %a$e = mm ST segment =1mmST segment =1mm pright or 4iphasi' Tpright or 4iphasi' T
Type 3 Saddle 4a'Type 3 Saddle 4a' J %a$e =mmJ %a$e =mm ST segment 1mmST segment 1mm Positi$e T %a$ePositi$e T %a$e
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9hat Type is &t:9hat Type is &t:
** BB CC
http://en.wikipedia.org/wiki/Image:Brugada.jpghttp://en.wikipedia.org/wiki/Image:Brugada.jpg -
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3 DiGerent Patterns3 DiGerent Patterns
FeatureFeature Type 1Type 1 Type Type Type 3Type 3
J %a$eJ %a$e ==mmmm ==mmmm ==mmmm
T %a$eT %a$e +egati$e+egati$e Positi$e orPositi$e or4iphasi'4iphasi' Positi$ePositi$e
ST;TST;T Co$edCo$ed Saddle4a'Saddle4a'
Saddle4a'Saddle4a'
STSTSegmentSegment
TerminalTerminalPortionPortion
)radual)radualdes'entdes'ent
Ele$atedEle$ated=1mm=1mm
Ele$atedEle$ated1mm1mm
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Transient +atureTransient +ature
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EpidemiologyEpidemiology
Pre$alen'e6Pre$alen'e6- Japan 1H!, Type 1 is 'ommon up to !H1@Japan 1H!, Type 1 is 'ommon up to !H1@
- Finland !H@, Type 1 is rareFinland !H@, Type 1 is rare
- S* !HIS* !HI )ender6)ender6
- Male >p to 70 more 'ommon?Male >p to 70 more 'ommon?
ChildrenChildren- 'onsider (e$er, syn'ope'onsider (e$er, syn'ope
*ge*ge- a$erage age o( diagnosis is I1a$erage age o( diagnosis is I1
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PathogenesisPathogenesis
)eneti's)eneti's- *utosomal dominant inheritan'e %ith*utosomal dominant inheritan'e %ith
$aria4le e0pression$aria4le e0pression
- Cardia' sodium 'hannel geneCardia' sodium 'hannel gene- +o stru'tural a4normalities+o stru'tural a4normalities
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*rrhythmias in Brugada*rrhythmias in Brugada
SyndromeSyndrome
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Pro$oing Fa'torsPro$oing Fa'tors
Sodium ImbalancesSodium Imbalances
Drugs6 Co'aineDrugs6 Co'aine
TC*s and +eurolepti'sTC*s and +eurolepti's
in o$erdosein o$erdose Sodium 'hannelSodium 'hannel
4lo'ers6 pro'ainamide4lo'ers6 pro'ainamide
Ele'trolyte &m4alan'es6Ele'trolyte &m4alan'es6
Sodium, Cal'iumSodium, Cal'ium .ithium.ithium
DrugsDrugs
B;4lo'ersB;4lo'ers
.o'al anestheti's.o'al anestheti's
Autonomic ToneAutonomic Tone
Fe$erFe$er
+ight+ight
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Ris Fa'tors (or SuddenRis Fa'tors (or Sudden
Cardia' DeathCardia' Death
MaleMale Family historyFamily history
*4normal EC)*4normal EC) &ndu'i4le
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#ut'ome (or Brugada#ut'ome (or Brugada
PatientsPatients
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DiagnosisDiagnosis
Type 1 ECG changes +Type 1 ECG changes + Do'umented
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TreatmentTreatment
/uinidine/uinidine
.ess indu'i4le
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Case 1Case 1
Male @ years old presents to FoothillsMale @ years old presents to Foothills
00 Presented to (amily MD, asymptomati'Presented to (amily MD, asymptomati' +o syn'ope+o syn'ope +o (amily history o( sudden 'ardia' death+o (amily history o( sudden 'ardia' death
PM0PM0 tn, yperlipidemiatn, yperlipidemia
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RBBB N ST Ele$ation
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Case 1Case 1
Re(erred to ele'trophysiology (orRe(erred to ele'trophysiology (or
(urther testing, and possi4le &CD(urther testing, and possi4le &CD
implantationHimplantationH
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Case Case
7 year old male7 year old male
00 Co'aine useCo'aine use
+o personal or (amily h0 o( syn'ope,+o personal or (amily h0 o( syn'ope,
sudden 'ardia' deathsudden 'ardia' death
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RBBB, ST ele$ation
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Case Case
EC) %hen not using 'o'aineEC) %hen not using 'o'aine
normalied o$er se$eral daysnormalied o$er se$eral days
&< Pro'ainamide (ailed to produ'e&< Pro'ainamide (ailed to produ'eBrugada 'hangesBrugada 'hanges
DiagnosisDiagnosis Co'aine;indu'ed EC) 'hangesCo'aine;indu'ed EC) 'hanges
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Case 3Case 3
7 year old Female7 year old Female
00 Presented to the ER a(ter 3 episodes o( palpitationsPresented to the ER a(ter 3 episodes o( palpitations
o$er 3 days, and a (eeling o( impending doomo$er 3 days, and a (eeling o( impending doom 0 o( sudden 'ardia' death in un'le at age IO0 o( sudden 'ardia' death in un'le at age IO +o h0 o( syn'ope+o h0 o( syn'ope
PM0PM0 ealthyealthy
MedsMeds +o medi'ations+o medi'ations
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Su4tle do%nsloping o( ST in
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Case 3Case 3
Cardiology 'onsult6Cardiology 'onsult6
Patient %as admitted to hospitalPatient %as admitted to hospital
Pro'ainamide 'hallenge ;K
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SummarySummary
Thin o( Brugada syndrome in aThin o( Brugada syndrome in a
patient %ith palpitations or syn'opepatient %ith palpitations or syn'ope
- Pseudo;RBBBPseudo;RBBB
- ST Ele$ation
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Re(eren'esRe(eren'es
BrugadaH Brugada Syndrome6 The #'ial 9e4site o(BrugadaH Brugada Syndrome6 The #'ial 9e4site o(the Ramon Brugada Senior FoundationHthe Ramon Brugada Senior FoundationH
http622%%%H4rugadaHorg2http622%%%H4rugadaHorg2 .aslo et alH Brugada;type ele'tro'ardiographi'.aslo et alH Brugada;type ele'tro'ardiographi'
pattern indu'ed 4y 'o'aineH Mayo Clin Pro'Hpattern indu'ed 4y 'o'aineH Mayo Clin Pro'H!!!QO6"IO;"I7H!!!QO6"IO;"I7H
http622%%%Hmayo'lini'pro'eedingsH'om2insideHasp:http622%%%Hmayo'lini'pro'eedingsH'om2insideHasp:*&DA1O!38&D*&DA1O!38&D
9atri'h et alH Brugada syndrome in a young patient9atri'h et alH Brugada syndrome in a young patient%ith palpitationsH CJEM !!O Q>O?6 3IQH%ith palpitationsH CJEM !!O Q>O?6 3IQH
http622%%%H'aepH'a2templateHasp:http622%%%H'aepH'a2templateHasp:idAD1C3F""BO1*I@ED"*Q"I"CDIB7*7C@idAD1C3F""BO1*I@ED"*Q"I"CDIB7*7C@
9ylie et alH Brugada syndrome and sudden 'ardia'9ylie et alH Brugada syndrome and sudden 'ardia'arrestH p To DateH June !!"HarrestH p To DateH June !!"H
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/uestions:/uestions:
Thans !orThans !orlistening"listening"