Brugada phenocopy in a patient with acute pulmonary embolism presenting with recurrent syncope

Abstract

Brugada phenocopy (BrP) refers to a group of clinical conditions that have etiologies distinct from Brugada syndrome (BrS). Although both demonstrate features of ST-segment elevation in the right precordial leads on the electrocardiogram (ECG), one must be distinguished from the other as their treatment options are different. We report a male patient who presented with recurrent syncope with a Brugada and a S1Q3T3 pattern on the ECG. Acute pulmonary embolism (APE) complicated by BrS was suspected. Twenty-four hours Holter monitoring did not demonstrate any evidence of ventricular arrhythmias. Computed tomography pulmonary angiogram confirmed the presence of an APE. He was treated with low molecular weight heparin and a repeat ECG taken the next day showed resolution of the Brugada and S1Q3T3 patterns. This case report illustrates that APE and BrS can present with similar clinical and electrocardiographic features of recurrent syncope and Brugada pattern, respectively.

An unusual ECG change after a car crash

“…The presentation and transient dynamic changes of ECGs in our case were compatible with the type 1 Brugada phenocopy (BrP), which are clinical entities that refer to ECG patterns identical to ECG presentations observed in Brugada syndrome ( de Oliveira Neto et al, 2019 ) . However, they may have different etiologies, such as metabolic conditions, mechanical compression, myocardial ischemia, pulmonary embolism, myocardial or pericardial disease, antiarrhythmic drug application, and others ( Baranchuk et al, 2012 ; Zhang et al., 2017 ; Sreenivasan et al, 2018 ; Gottschalk et al., 2016 ) . The potential reason for the BrP in our case may be associated with chest blunt trauma.…”

Brugada phenocopy or congenital Brugada syndrome in a patient with spontaneous pneumopericardium and pericarditis

“…He described it as a BrP with pericarditis as an underlying cause. Recently, there have been many reports describing the etiologies of BrP such as acute pericarditis 1 , myocardial ischemia, 2 Takotsubo cardiomyopathy, 3 and pulmonary embolism 4 . Contrary to the characteristic of ECG in BrP, the ECG pattern in congenital BrS is often dynamic and sometime may be concealed which could be unmasked by fever, sodium channel blockers, or recording ECG at the higher lead positions.…”

High risk electrocardiographic markers in Brugada syndrome

“…Although the type 1 ECG pattern is diagnostic for BrS, the type 2 pattern requires diagnostic distinction between true BrS and different clinical entities (myocardial ischemia, pulmonary embolism, electrolyte abnormalities), the so called Brugada phenocopies [ 12 ], which may develop a similar ECG pattern in mimicking conditions such as coronary artery dissection [ 13 ], myocardial infarction [ 14 ], hyperkalaemia [ 15 ], or pulmonary embolism [ 16 ]. Therefore, a careful assessment of the ECG is required in order to make an accurate diagnosis.…”