Download - Brugada Syndrome ECG

7/24/2019 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"

Download - Brugada Syndrome ECG

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