Case Presentation: A 25-year-old male with no significant past medical and family history presented with a one-week history of fever, productive cough, intermittent shortness of breath, diffuse muscle aches and one episode of syncope on the day of presentation. Initial workup in the emergency department was positive for COVID-19. Inflammatory markers, D-dimer and Fibrinogen levels were elevated. Troponin was normal. A Chest x-ray showed multifocal pneumonia. Computed tomography was negative for pulmonary embolism. An electrocardiogram showed coved ST segment elevation with T-wave inversion in the right precordial leads specifically evident in V1. A presumptive diagnosis of Brugada syndrome was made. Cardiology was consulted along with an electrophysiology consult. The transthoracic echocardiogram was obtained that was normal with EF of 65%. Electrophysiology confirmed presence of Type-1 Brugada syndrome on repeat EKG testing. Subsequently, the patient underwent automatic implantable cardioverter defibrillator placement and discharged with cardiology follow-up.
Discussion: Brugada Syndrome is a rare inherited cardiac arrhythmia due to decrease in number or function of sodium channels, characterized by pseudo right bundle block and persistent coved ST elevation in right precordial leads. It is predominant in younger male group with structurally normal heart. Initial presentation is usually with Syncope and/or aborted sudden cardiac arrest. Multiple factors have been associated with exacerbation of Brugada syndrome including fever, alcohol, and pro-arrhythmic medications. Myocardial inflammation associated with COVID19 can be a risk factor for unmasking Brugada Syndrome, however further research needs to be done to confirm this association. Treatment is primarily focused on prevention of SCD with ICD or Life Vest placement.
Conclusions: COVID-19 related myocardial complications has seen upward trend ever since its declaration as global pandemic in March 2020. Multiple arrhythmogenic complications including supraventricular tachycardia, V-tach, V fib, sudden cardiac death has been reported. However, unmasking of inherited arrhythmias in younger individuals with COVID-19 remained a rare incidence overall.
