BOF: 2.20
An 18-year-old male from Thailand presents with a history
of syncope. No other symptoms, no significant past medical history. He does
not smoke or drink and does not abuse drugs. There are no abnormalities
detectable on clinical examination.
His ECG shows right bundle branch block with J point
elevation and concave ST elevation in leads V1-V3.
The diagnosis is:
a)
Antero-septal myocardial infarction
b)
Pericarditis
c)
Ventricular aneurysm
d)
Brugada syndrome
e)
Wolfe-Parkinson-White syndrome
Answer:
d)
Treatment should be with:
a)
Implantable cardioverter defibrillator
b)
Sotalol
c)
Thrombolysis
d)
High dose steroids
e)
Repair of the aneurysm
Answer:
a)
The patient has the features of Brugada syndrome (Sudden
Unexpected Death Syndrome).
A previously well asymptomatic young man is unlikely to
have had a myocardial infarction, pericarditis or ventricular aneurysm.
The ECG changes are not suggestive of WPW syndrome.
Treatment of Brugada syndrome is with an implantable
cardioverter defibrillator.
Brugada syndrome
