Is coronary angiography an adequate diagnostic test to evaluate a young febrile patient with ST elevation?Genç febril ve ST elevasyonlu bir hasta değerlendirilmesinde koroner anjiyografi yeterli tetkik midir?
IntroductionBrugada syndrome (BS) is a rare condition characterized by ST-segment elevation in the right precordial leads. It is associated with ventricular arrhythmias, and is responsible for 20% of sudden cardiac deaths (SCD). Fever can induce Brugada-like electrocardiographic (ECG) changes and precipitate ventricular fibrillation (VF).We would like to discuss a case of 31-year-old male who developed hypoxic ischemic encephalopathy.
Case ReportA 31-year-old male was brought to our emergency room after about 15 minutes of apparent cardiac arrest. VF was seen, and he was defibrillated once with 200 J. After 10 minutes of successful resuscitation, he was transferred to intensive care unit. He was discharged without any further investigations. The surface ECG was consistent with type 1 Brugada pattern. Transthoracic echocardiography showed normal findings. Acute coronary syndromes, pulmonary embolism and electrolyte imbalance were excluded, and the patient was considered as a case of BS presenting with VF. Neurology consultation confirmed hypoxic ischemic encephalopathy, and the follow-up under the support of mechanical ventilation was continued in the intensive care unit.On the 12 th day, he had fever, and Methicillin-resistant Staphylococcus aureus was cultured from his tracheal aspirate. Dynamic changes on his surface ECG were detected during this period of increased body temperature. The apparently normal ECG at 36.9°C developed a pattern with a wider QRS complex and elevated J point at 38.8°C (Fig. 1). When the medical history was taken in detail, it was learned that 2 years ago, the patient underwent coronary angiography for a febrile illness accompanied by ST segment elevations and chest pain, probably due to myalgia. However, the coronary angiogram was found to be normal.