Brugada syndrome differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Abnormalities that can lead to ST-segment elevation in the right precordial leads include the following:[1]
- Acute myocardial ischemia or infarction
- Acute myocarditis
- Acute pericarditis
- Acute pulmonary thromboemboli
- Arrhythmogenic right ventricular dysplasia / cardiomyopathy (ARVD/C)
- Cocaine intoxication
- Coronary spasm
- Dissecting aortic aneurysm
- Duchenne muscular dystrophy
- Early repolarization
- Friedreich ataxia
- Heterocyclic antidepressant overdose
- Hypercalcemia
- Hyperkalemia
- Hypothermia, causing Osborn wave in ECGs and sometimes resembling Brugada syndrome
- Left ventricular hypertrophy
- Prinzmetal's angina[2]
- Mediastinal tumor compressing the right ventricular outflow tract (RVOT)
- Right (atypical) or left bundle-branch block
- Right ventricular infarction
- Right ventricular ischemia
- Thiamine deficiency
- Various central and autonomic nervous system abnormalities
- Other conditions that can lead to ST-segment elevation in the right precordial leads
- Early repolarization syndrome
- Other normal variants (particularly in males)
Prinzmetal angina,[http//circ.ahajournals.org/content/111/5/659.full?sid=52a12e4b-8533-4741-9be3-49a596258e4b#ref-21 21] dissecting aortic aneurysm,[http//circ.ahajournals.org/content/111/5/659.full?sid=52a12e4b-8533-4741-9be3-49a596258e4b#ref-22 22] various central and autonomic nervous system abnormalities,[http//circ.ahajournals.org/content/111/5/659.full?sid=52a12e4b-8533-4741-9be3-49a596258e4b#ref-23 23,24] Duchenne muscular dystrophy,[http//circ.ahajournals.org/content/111/5/659.full?sid=52a12e4b-8533-4741-9be3-49a596258e4b#ref-25 25] thiamin deficiency,[http//circ.ahajournals.org/content/111/5/659.full?sid=52a12e4b-8533-4741-9be3-49a596258e4b#ref-26 26] hyperkalemia,[http//circ.ahajournals.org/content/111/5/659.full?sid=52a12e4b-8533-4741-9be3-49a596258e4b#ref-22 22,27,28] hypercalcemia,[http//circ.ahajournals.org/content/111/5/659.full?sid=52a12e4b-8533-4741-9be3-49a596258e4b#ref-29 29,30] arrhythmogenic right ventricular dysplasia/cardiomyopathy,[http//circ.ahajournals.org/content/111/5/659.full?sid=52a12e4b-8533-4741-9be3-49a596258e4b#ref-31 31,32] pectus excavatum,[http//circ.ahajournals.org/content/111/5/659.full?sid=52a12e4b-8533-4741-9be3-49a596258e4b#ref-33 33] hypothermia,[http//circ.ahajournals.org/content/111/5/659.full?sid=52a12e4b-8533-4741-9be3-49a596258e4b#ref-34 34,35] and mechanical compression of the right ventricular outflow tract (RVOT) as occurs in mediastinal tumor[http//circ.ahajournals.org/content/111/5/659.full?sid=52a12e4b-8533-4741-9be3-49a596258e4b#ref-36 36] or hemopericardium.[http//circ.ahajournals.org/content/111/5/659.full?sid=52a12e4b-8533-4741-9be3-49a596258e4b#ref-37 37]
Of note, a Brugada-like ECG can occasionally appear for a brief period or for a period of several hours after direct-current cardioversion; it is not known whether these patients are gene carriers for Brugada syndrome.[http//circ.ahajournals.org/content/111/5/659.full?sid=52a12e4b-8533-4741-9be3-49a596258e4b#ref-38 38–40]
References
- ↑ Takehara N, Makita N, Kawabe J, Sato N, Kawamura Y, Kitabatake A, Kikuchi K (2004). "A cardiac sodium channel mutation identified in Brugada syndrome associated with atrial standstill". Journal of Internal Medicine. 255 (1): 137–42. PMID 14687250. Retrieved 2012-10-13. Unknown parameter
|month=ignored (help) - ↑ Wang K, Asinger RW, Marriott HJ (2003). "ST-segment elevation in conditions other than acute myocardial infarction". The New England Journal of Medicine. 349 (22): 2128–35. doi:10.1056/NEJMra022580. PMID 14645641. Retrieved 2012-10-13. Unknown parameter
|month=ignored (help)