Biggs, Ross, DO

Bozorgnia, Babak, MD

Khan, Jahangir, MD

Muhammed, Q, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineRhabdomylosis Induced Type 1 Pattern BrugadaSyndrome: A Differential Not to be ForgottenRoss Biggs DOLehigh Valley Health Network, Ross.Biggs@lvhn.orgJahangir Khan MDLehigh Valley Health Network, Jahangir.Khan@lvhn.orgQ Muhammed MDBabak Bozorgnia MDLehigh Valley Health Network, Babak.Bozorgnia@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/medicinePart of the Medical Sciences CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtBiggs, R. G., Khan, J. Muhammed, Q. Bozorgnia, B. (2017, April 27). Rhabdomylosis Induced Type 1 Pattern Brugada Syndrome: ADifferential Not to be Forgotten. Poster Presented at: 2017 Annual POMA Clinical Assembly/Convention, Philadelphia, PA.© 2017 Lehigh Valley Health NetworkCONCLUSIONBrugada Syndrome is a rare genetic mutation caused by a disruption of proteins regulating cardiac sodium channels effecting 0.012 to 0.4% of the U.S. population with type 1 pattern being the rarest of the 3 classic patterns.1  The type 1 ECG pattern has coved ST-segment elevation in V1-V32, and patients can present asymptomatic, with syncope or sudden cardiac death (SCD).1Brugada syndrome is a rare, but critical diagnosis which cannot be missed as the risk of sudden cardiac death is greatly increased from the normal population.  This case emphasizes the need for recurrent evaluation in patient with Brugada pattern on ECG.Rhabdomylosis Induced Type 1 Pattern Brugada Syndrome: A Differential Not to be ForgottenReferences:1.  Gourraud, Jean-Baptiste, et al. “Brugada syndrome: Diagnosis, risk stratification and management.” Archives of Cardiovascular Diseases (2017).2.  John, Roy M., and William G. Stevenson. “Ventricular Arrhythmias.” Harrison’s Principles of Internal Medicine, 19e Eds. Dennis Kasper, et al. New York, NY: McGraw-Hill, 2014, http://accessmedicine.mhmedical.com/content.aspx?bookid=1130&sectionid=79742328.3.  Probst V., Chatel S., Gourraud J.B., and Marec H.L. “Risk stratification and therapeutic approach in Brugada syndrome.” Arrhythm Electrophysiol Rev 2012; 1: pp. 17-21.METHODSA 52 y/o male presented as a transfer to our facility after a syncopal event in his vehicle.  The patient was a previously healthy male with no family history of SCD.  At the outside facility, he was found to have rhabdomyolysis, severe electrolyte abnormalities and Brugada type I pattern, so he was transferred to our facility for Electrophysiology (EP) evaluation. Images 1: Electrocardiogram demonstrating Type I Brugada pattern.Figure 1: Electrocardiogram patterns of Brugada syndrome.  Only a type 1 ECG allows diagnosis of Brugada syndrome.  Positive sodium channel blocker testing is required for types 2 and 3 to diagnose Brugada syndrome. (1)Figure 2: Indication for implantation of an implantable cardioverter defibrillator (ICD), according to the risk of sudden cardiac death (SCD). The risk of SCD is represented with a red arrow. The red boxes represents an indication for ICD implantation; the green box represents a patient who should not be implanted, according to the latest guidelines; the orange boxes are not addressed in the guidelines. (1)The patient underwent a flecainide challenge and EP study, which was inconclusive and he was discharged on metoprolol.  He followed up with EP as an outpatient and was noted on routine ECG to have return of his Brugada Type 1 pattern.  He underwent successful implantation of a defibrillator for primary prevention of SCD due to high risk features of prior syncope, recurrent Brugada pattern, and male age.1 Department of Medicine, 2Department of Cardiology, Lehigh Valley Health Network, Allentown, PARG Biggs DO1, J Khan MD1, Q Muhammed MD1, and B Bozorgnia MD2RESULTSINTRODUCTION

Rhabdomylosis Induced Type 1 Pattern Brugada Syndrome: A Differential Not to be Forgotten

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Rhabdomylosis Induced Type 1 Pattern Brugada Syndrome: A Differential Not to be Forgotten

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