Slide 1: A 35 year-old male with body aches, fever, and chills presents to the ER with syncope without prodromal symptoms. You get an EKG…

Slide 2: What does the EKG show?

Slide 3: This is Brugada sign or a Type 1 Brugada pattern!

Type 1 – STE > 2 mm, T-wave inversions (TWI), “coved” ST elevation
Type 2 – STE > 2 mm, no TWI, “saddleback”
Type 3 – STE < 2 mm, type 1 or type 2 morphology Tip: EKG leads can be moved to the 2nd intercostal space to better capture these findings! Slide 4: Brugada vs RBBB? The beta-angle is measured between the upslope of the S wave and the downslope of the following R- wave. The beta angle of >58 degrees suggests a Brugada pattern.

Slide 5: Diagnostic criteria for Brugada Syndrome. EKG and >1 of the following clinical findings. History of V-fib or polymorphic VT, history of sudden cardiac death, syncope suggestive of arrhythmia, nocturnal agonal respiration, inducible VT, family history of Type 1 Brugada or sudden cardiac death in a young person.

Our patient fits the criteria!

Slide 6: Next steps – genetic testing for mutations in sodium channels. Avoid precipitating factors. Fever, electrolytes imbalances, alcohol, sodium channel blockers. Consider implantable ICD. If history of sudden cardiac death or syncope from arrhythmias!

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