Introduction: Right bundle branch block with ST-segment elevation in leads V1 through V3 is the electrocardiographic (ECG) marker of the Brugada pattern. The Brugada pattern was first described as a genetically, autosomal dominant, determined disease caused by mutation in the sodium channel. However over time, the Brugada pattern has also been reported to be transient, often exposed by a sodium channel blocker, such as flecainide, or procainamide in patients with latent Brugada syndrome. We describe a case of a healthy young man with a normal baseline ECG in whom a transient Brugada pattern was observed after recreational cocaine use. To our knowledge this is a very rare phenomenon and only a few cases have been reported. This case illustrates that, in susceptible individuals, cocaine may provoke the Brugada pattern.

Case Presentation: A 48-year-old man with no past medical history came to the emergency room with chest pain. Blood pressure was 130/80 mm Hg and Sat O2, 98%. The physical examination was unremarkable. The electrocardiogram (ECG) showed sinus rhythm at 88 beats per minutes, complete right bundle branch block, and ST segment elevation of more than 2 mm in V1-V3. Previous ECG’s were unremarkable. The chest x-ray was normal. The general serum analyses showed no alterations, with the urinalysis positive for cocaine. He denied having a family history of sudden cardiac death or a personal history of palpitation, pre-syncope, or syncope. We conducted serial ECG to monitor for dynamic changes and treated the patient conservatively. Over the course of the next day the ECG changes slowly dissipated. The patient was discharged home and on one month follow up the ECG was unremarkable.

Discussion: The incidence of Brugada syndrome is estimated at 0.05 to 0.6 percent in adults and 0.0006 percent in children, suggesting that the syndrome manifests primarily during adulthood. Patients with Brugada syndrome have an estimated 30 percent chance of sudden cardiac death.2 However the incidence of cardiac death or clinical significance of latent Brugada syndrome has not been well studied. There is now growing interest in the mechanisms responsible for acquired Brugada syndrome and its clinical significance.

Conclusions: Our case aims to highlight that in susceptible individuals, cocaine may provoke the Brugada pattern even in the absence of a genetic history and that additional research must be done to understand this phenomena.