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

• Acute myocardial ischemia or infarction
• Acute myocarditis
• Acute pericarditis
• Acute pulmonary thromboemboli
• Arrhythmogenic right ventricular dysplasia / cardiomyopathy (ARVD/C)
• Cocaine intoxication
• 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
• 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]