Syncope in a Young Man

Yıl 2018, Cilt: 9 Sayı: 1, 4 - 7, 01.01.2018

Estelle Mei Chen Chng Eeling Goh

Öz

Introduction: Syncope is a common complaint in the emergency department, accounting for 1%–3% of all visits and hospital admissions. Most causes are often benign and self-limited allowing safe discharge. However, others, particularly those resulting from cardiac syncope, are associated with significant morbidity and mortality. An electrocardiogram (ECG) is essential in addition to clinical history and physical examination for risk stratification. It is useful for identifying patients with inherited syndromes that predispose them to cardiac arrhythmias.Case Report: We report a case of a young man who presented with syncope to the emergency department. He was asymptomatic on arrival, but subsequently developed seizures secondary to ventricular fibrillation that required defibrillation. His initial ECG revealed characteristics of type 1 Brugada syndrome. The patient was fitted with an internal cardiac defibrillator and was discharged. We discuss the presentation, pathophysiology, and management of patients with Brugada syndrome.Conclusion: In patients presenting with syncope, ECG is essential for risk stratification and identifying patients with possible inherited syndromes. A high index of suspicion is necessary for diagnosing

Anahtar Kelimeler

Syncope, Brugada syndrome, electrocardiogram

Kaynakça

• Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocar- diographic syndrome. A multicenter report. J Am Coll Cardiol 1992; 20: 1391-6. [CrossRef]
• Chen Q, Kirsch GE, Zhang DM, Brugada R, Brugada J, Brugada P, et al. Genetic basis and molecular mechanism for idiopathic ventricular fibril- lation. Nature. 1998; 392; 293-6. [CrossRef]
• Benito B, Sarkozy A, Mont L, Henkens S, Bernuezo A, Tamborero D, et al. Gender differences in clinical manifestations of Brugada syndrome. J Am Coll Cardiol 2008; 52: 1567-73. [CrossRef]
• Brugada J, Brugada R, Brugada P. Determinants of sudden cardiac death in individuals with the electrographic pattern of Brugada syn- drome and no previous cardiac arrest. Circulation 2003; 108: 3092-6. [CrossRef]
• Brugada P, Benito B, Brugada R, Brugada J. Brugada Syndrome: Update 2009. Hellenic J Cardiol 2009; 50: 352-72.
• Antzelevitch C, Brugada P, Borggrefe M, Brugada J, Brugada R, Corredo D, et al. Brugada syndrome: report of the second consensus confer- ence: endorsed by the Heart Rhythm Society and the European Heart Rhythm Association. Circulation 2005; 111: 659-70. [CrossRef]
• Priori SG, Napolitano C, Gasparini M, Pappone C, Della Bella P, Giordano U, et al. Natural history of Brugada syndrome: insights for risk stratifica- tion and management. Circulation 2002; 105: 1342 -7. [CrossRef]
• Hirata K, Takagi Y, Nakada M, Kyushima M, Asato H. Beat to beat variation of the ST segment in a patient with right bundle branch block, persis- tent ST segment elevation, and ventricular fibrillations: a case report. Angiology 1998; 48: 87-90. [CrossRef]
• Veltmann C, Schimpf R, Echternach C, Eckardt L, Kuschy J, Streitner F, et al. A prospective study on spontaneous fluctuations between diag- nostic and non-diagnostic ECGs in Brugada syndrome: implications for correct phenotyping and risk stratification. Eur Heart J 2006; 27: 2544- 52. [CrossRef]
• Kusano KF, Taniyama M, Nakamura K, Miura D, Banba K, Nagase S, et al. Atrial fibrillation in patients with Brugada syndrome relationships of gene mutation, electrophysiology, and clinical backgrounds. J Am Coll Cardiol 2008; 51:1169-75. [CrossRef]
• Available from: http://www.brugadadrugs.org
• Brugada J, Brugada R, Antzelevitch C, Towbin J, Nademanee K, Brugada P. Long term follow-up of individuals with the electrocardiographic pat- tern of right bundle-branch block and ST-segment elevation in precor- dial leads V1-V3. Circulation 2002; 105: 73-8. [CrossRef]
• Sacher F, Probst V, Maury A, Babuty D, Mansourati J, Komatsu Y, et al. Outcome after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: a multicenter study. Circulation 2006; 114: 2317-24. [CrossRef]
• Priori SG, Blomstrom-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the Euro- pean Society of Cardiology (ESC). Endorsed by: Association for Euro- pean Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2015; 36: 1793-867. [CrossRef]
• Ohgo T, Okamura H, Noda T, Satomi K, Suyama K, Kurita T, et al. Acute and chronicmanagement in patients with Brugada syndrome associ- ated with electrical storm of ventricular fibrillation. Heart Rhythm 2007; 4: 695-700. [CrossRef]
• Shen WK, Sheldon RS, Benditt DG, Mitchell IC, Forman DE, Goldberger ZD, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Manage- ment of Patients with Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Circulation 2017; 136: e60- e122. [CrossRef]