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[2]
- Duchenne muscular dystrophy[3]
- 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[4]
- 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)
Duchenne muscular dystrophy thiamin deficiency hyperkalemia hypercalcemia arrhythmogenic right ventricular dysplasia/cardiomyopathy, pectus excavatum hypothermia and mechanical compression of the right ventricular outflow tract (RVOT) as occurs in mediastinal tumor or hemopericardium
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.
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) - ↑ Myers GB. Other QRS-T patterns that may be mistaken for myocardial infarction; IV. Alterations in blood potassium; myocardial ischemia; subepicardial myocarditis; distortion associated with arrhythmias. Circulation. 1950; 2: 75–93.
- ↑ Perloff JK, Henze E, Schelbert HR. Alterations in regional myocardial metabolism, perfusion, and wall motion in Duchenne muscular dystrophy studied by radionuclide imaging. Circulation. 1984; 69: 33–42.
- ↑ 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)