A 24 year old male presented for cardiology evaluation after a syncopal episode. At the time of the
event, he experienced dizziness and was witnessed to fall and hit his head. Neurological
assessment was unremarkable. Echocardiogram showed normal cardiac architecture and function.
During cardiology follow up, past history was thoroughly examined. The patient denied any previous
episodes of syncope, exertional dyspnea or chest pain. His father died at the age of 41 after an
unwitnessed motor vehicle accident. The physical exam was overall benign. Initial
electrocardiogram showed normal sinus rhythm with Incomplete Right Bundle Branch Block
(IRBBB). No ST segment changes were visualized, but abnormal repolarization after the R prime
was reported. Electrophysiology consult was placed. While the patient was having routine
laboratory measurements, he experienced another episode of syncope. He was referred directly to
the Emergency Department where repeated EKG demonstrated IRBBB, this time with more than 2mm
“coved” ST segment elevations in leads V1-V2. The diagnosis of Brugada Syndrome was made.
Subsequently, his electrocardiographic activity ranged from normal sinus rhythm to coved and
saddleback ST elevations in the anterior leads. Promptly, the patient underwent Subcutaneous
Defibrillator Implantation without further events
Discussion:
RBB has been typically considered a benign finding in young adults . However,
multiple studies continue to show the increased risk of adverse cardiovascular outcomes for
patients with RBBB . This young healthy male with unprovoked syncope presented with a generally
considered benign electrocardiographic finding. More than one EKG was necessary to establish a
diagnosis, proof of the dynamic electrical activity of patients with Brugada syndrome.
Conclusions:
Brugada is a well established syndrome, with the only treatment showed to decrease
mortality is ICD implantation especially in the 1st 2 types. To our knowledge this is the only case in
literature that shows 3 EKG findings of all Brugada Subtypes in 1 patient. Dynamic EKG changes in
the ST segment are predictors of a worse outcome shown especialy from this patient’s family
history, therefore a detailed analysis of the past family history and interdisciplinary approach are
critical to the institution of appropriate therapeutic intervention. Above all, this case emphasizes the
relevance of a meticulous analysis of all ECG findings in the setting of a suspicious clinical contex.
Brugada syndrome is a hereditary arrhythmia characterized by a specific
electrocardiographic pattern and an increased risk of sudden cardiac death, with an apparent
absence of structural abnormalities or ischemic heart disease,it consists of 3 types. Our case of is of a 24 year male who presented with EKG changes consistent with all the 3 types
during his hospital stay. We were able to upload only one image in this abstract however we will present EKGs of all 3 types in the same individual.