Case #7

A 24 year old male is admitted to your ER complaining of "black out" He states that prior to balcking out he felt "his heart racing". THis happened once before about a week ago but he didnt black out at that time. This is the admission EKG. Further work up also showed a normal echo with no structural abnormalities. What diagnosis are you entertaining with the EKG below

Click here for better quality image of EKG

This is an example of the EKG findings of what is known as "Brugada Syndrome". It is an extrememly rare disease charecterised by a trio of 1) a right bundle branch block pattern in the right precordial leads of the electrocardiogram, 2) transient or persistent ST-segment elevation in leads V1 to V3 , and 3) sudden cardiac death. Patients may also report a history of syncope or palpitations and usually have no structural heart disease. The findings on this EKG of RBBB and ST elevations in v1 to v3 along with the history made this syndrome highly likely. Follow up EP study showed that V-Tach was inducible buying him an ICD which will most likely save his life. Here is a good algorhythm when considering the diagosis.

American Heart JournalVolume 145 • Number 5 • May 2003