Brugada syndrome electrocardiogram: Difference between revisions
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==Overview== | ==Overview== | ||
In some cases, the disease can be detected by observing characteristic patterns on an [[electrocardiogram]], which may be present all the time, or might be elicited by the administration of particular drugs (e.g., Class IC antiarrythmic drugs that blocks sodium channels and causing appearance of ECG abnormalities - [[ajmaline]], [[flecainide]]) or resurface spontaneously due to as yet unclarified triggers. The pattern seen on the ECG is persistent ST elevations in the electrocardiographic leadsV<sub>1</sub>-V<sub>3</sub> with a [[right bundle branch block]] ([[RBBB]]) appearance with or without the terminal S waves in the lateral leads that are associated with a typical [[RBBB]]. A prolongation of the [[PR interval]] (a conduction disturbance in the heart) is also frequently seen.The electrocardiogram can fluctuate over time, depending on the autonomic balance and the administration of antiarrhythmic drugs. Adrenergic stimulation decreases the [[ST segment]] elevation, while vagal stimulation worsens it. (There is a case report of a patient who died while shaving, presumed due to the vagal stimulation of the carotid sinus massage!) The administration of class Ia, Ic and III drugs increases the [[ST segment]] elevation, and also fever. Exercise decreases [[ST segment]] elevation in some patients but increases it in others (after exercise when the body temperature has risen). The changes in heart rate induced by atrial pacing are accompanied by changes in the degree of [[ST segment]] elevation. When the heart rate decreases, the [[ST segment]] elevation increases and when the heart rate increases the [[ST segment]] elevation decreases. However, the contrary can also be observed. | In some cases, the disease can be detected by observing characteristic patterns on an [[electrocardiogram]], which may be present all the time, or might be elicited by the administration of particular drugs (e.g., Class IC antiarrythmic drugs that blocks sodium channels and causing appearance of ECG abnormalities - [[ajmaline]], [[flecainide]]) or resurface spontaneously due to as yet unclarified triggers. The pattern seen on the ECG is persistent ST elevations in the electrocardiographic leadsV<sub>1</sub>-V<sub>3</sub> with a [[right bundle branch block]] ([[RBBB]]) appearance with or without the terminal S waves in the lateral leads that are associated with a typical [[RBBB]]. A prolongation of the [[PR interval]] (a conduction disturbance in the heart) is also frequently seen.The electrocardiogram can fluctuate over time, depending on the autonomic balance and the administration of antiarrhythmic drugs. Adrenergic stimulation decreases the [[ST segment]] elevation, while vagal stimulation worsens it. (There is a case report of a patient who died while shaving, presumed due to the vagal stimulation of the carotid sinus massage!) The administration of class Ia, Ic and III drugs increases the [[ST segment]] elevation, and also fever. Exercise decreases [[ST segment]] elevation in some patients but increases it in others (after exercise when the body temperature has risen). The changes in heart rate induced by atrial pacing are accompanied by changes in the degree of [[ST segment]] elevation. When the heart rate decreases, the [[ST segment]] elevation increases and when the heart rate increases the [[ST segment]] elevation decreases. However, the contrary can also be observed. | ||
== | ==Type 1 Brugada Syndrome== | ||
As shown by the racing below, The EKG characteristics of Bugada syndrome include the following EKG findings in the right precordial leads (V<sub>1</sub>-V<sub>3</sub>): | As shown by the racing below, The EKG characteristics of Type 1 Bugada syndrome include the following EKG findings in the right precordial leads (V<sub>1</sub>-V<sub>3</sub>): | ||
*a) A broad [[P-wave]] with some [[PQ prolongation]] | *a) A broad [[P-wave]] with some [[PQ prolongation]] | ||
*b) [[J point]] elevation in the right precordial leads (V<sub>1</sub>-V<sub>3</sub>) | *b) [[J point]] elevation in the right precordial leads (V<sub>1</sub>-V<sub>3</sub>) |
Revision as of 14:06, 14 October 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
In some cases, the disease can be detected by observing characteristic patterns on an electrocardiogram, which may be present all the time, or might be elicited by the administration of particular drugs (e.g., Class IC antiarrythmic drugs that blocks sodium channels and causing appearance of ECG abnormalities - ajmaline, flecainide) or resurface spontaneously due to as yet unclarified triggers. The pattern seen on the ECG is persistent ST elevations in the electrocardiographic leadsV1-V3 with a right bundle branch block (RBBB) appearance with or without the terminal S waves in the lateral leads that are associated with a typical RBBB. A prolongation of the PR interval (a conduction disturbance in the heart) is also frequently seen.The electrocardiogram can fluctuate over time, depending on the autonomic balance and the administration of antiarrhythmic drugs. Adrenergic stimulation decreases the ST segment elevation, while vagal stimulation worsens it. (There is a case report of a patient who died while shaving, presumed due to the vagal stimulation of the carotid sinus massage!) The administration of class Ia, Ic and III drugs increases the ST segment elevation, and also fever. Exercise decreases ST segment elevation in some patients but increases it in others (after exercise when the body temperature has risen). The changes in heart rate induced by atrial pacing are accompanied by changes in the degree of ST segment elevation. When the heart rate decreases, the ST segment elevation increases and when the heart rate increases the ST segment elevation decreases. However, the contrary can also be observed.
Type 1 Brugada Syndrome
As shown by the racing below, The EKG characteristics of Type 1 Bugada syndrome include the following EKG findings in the right precordial leads (V1-V3):
- a) A broad P-wave with some PQ prolongation
- b) J point elevation in the right precordial leads (V1-V3)
- c) Coved ST segment elevation
- d) An inverted T wave
Typically these changes are in the right precordial leads but these EKG changes can occur on the inferior [1] or left precordial leads[2]. The fact that these cases may represent atypical variants of Brugada syndrome is supported by the observation that these cases were associated with SCN5A genetic abnormalities.
Provocation of EKG Changes
The findings of Brugada syndrome are often concealed, but can be unmasked or modulated by a number of drugs and pathophysiological states including sodium channel blockers, a febrile state, vagotonic agents that mimic sleep, tricyclic antidepressants, as well as cocaine and Propranolol intoxication.
EKG Images
Shown below is an example of lead placements in Brugada syndrome.
Shown below is an example of general EKG characteristics in Brugada syndrome - right bundle branch block in leads V1-2 and ST segment elevation in leads V1-3
Shown below is an example of Brugada syndrome with ST segment elevation.
Shown below are examples of Brugada syndrome type 1 showing J point elevation, right bundle branch block and T wave inversion.
Shown below are examples of Brugada sydrome type 2 showing J point elevation, saddle shaped ST segment.
Shown below is an example of Brugada syndrome with right bundle branch block in V1 and St segment elevation in V1-3
References
- ↑ Kalla H, Yan GX, Marinchak R (2000). "Ventricular fibrillation in a patient with prominent J (Osborn) waves and ST segment elevation in the inferior electrocardiographic leads: a Brugada syndrome variant?". Journal of Cardiovascular Electrophysiology. 11 (1): 95–8. PMID 10695469. Unknown parameter
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(help) - ↑ Horigome H, Shigeta O, Kuga K, Isobe T, Sakakibara Y, Yamaguchi I, Matsui A (2003). "Ventricular fibrillation during anesthesia in association with J waves in the left precordial leads in a child with coarctation of the aorta". Journal of Electrocardiology. 36 (4): 339–43. PMID 14661171. Retrieved 2012-10-14. Unknown parameter
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