Brugada Syndrome
Started by MGG1848
nice pull--there's actually a pretty good lecture on emrap tv for those interested:
http://www.emrap.tv/index.php?option=com_content&view=article&id=2206:EMRAPTV65-ECG-Syncope
http://www.emrap.tv/index.php?option=com_content&view=article&id=2206:EMRAPTV65-ECG-Syncope
I actually Dx'd one and it was textbook:
southeast asian male, young 20's, presented s/p syncope, two witnessed episodes of syncope in ED during which he went into brief episodes of v tach, family hx included father and brother who suddenly dies in their 30's for no apparent reason.
EKG displayed classic "saddleback" sign in V1-V3
southeast asian male, young 20's, presented s/p syncope, two witnessed episodes of syncope in ED during which he went into brief episodes of v tach, family hx included father and brother who suddenly dies in their 30's for no apparent reason.
EKG displayed classic "saddleback" sign in V1-V3
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So do these people automatically get ICDs?
Not always. We usually just send a tech to "borrow" an AED from the mall, rig up some Zol pads, and send 'em out with the EP clinic number.
I diagnosed one a few months out of residency. 12-lead by EMS showed what looked like Brugada, but our EKG in the ER was normal. Had cardiology (you know who they are) come look at them, and they said he was fine and wanted to send him home. While they were down there talking to me, he went into VT for about 90 seconds. By the time we got the paddles on him, he was back in NSR. Repeat EKG showed Brugada. Cardiology ended up admitting him to the ICU. Go figure.
From d/c home to admit to highest level of care possible...gotta love it!
I had almost the exact same patient sometime in September, only one I've caught. No VT in the ED but had the heritage, family story, pattern, and ultimately inducible electrophysiology to confirm the Dx.
I'm assuming you are joking, but would giving the patient an AED while they wait for their installment of an ICD be overkill?
You have to order an AED in nearly all cities. So what are you going to do for the 2-3 days until it's delivered?
The same thing you'll do while waiting for implantation of the AICD... admit them. Syncope + Brugada would be a slam dunk for me. Still waiting to see it (and recognize it I should probably add).
Or perhaps you can give them battery cables, show them how to attach to their nipples and wish them well.
Take care,
Jeff
I actually wonder how many of these get missed as the EKG machines typically read them as a RBBB. How many times has an EKG been given to you at a bad time when your busy and you only quickly glance at it thinking you just look at it again when you go to see the PT? Luckily when this guy's was done I sitting down and truelly studying it. It was a textbook EKG for Brugada's w/ the "saddleback" sign in the V2-V3 like a cardiologist had told me one time. This guy sat me down on my cardio roatation and told me the biggest zebra's EM picks up on EKG's are WPW and Brugada's, here's what to look for.
I worry sometimes about how much gets missed in EM. Like you scan someone's T spine because that's where their pain is but oh what the hell you just scan the whole spine and find and epidural abscess. One quik keystroke and the pt would have been dead in 48 hrs. Someone presents for nausea and the voice in the back of your head thinks: "hey this lady is post menopausal, DM, has HTN, and has no PMD. This just might be ACS". You run a trop and its 5.2 . I've seen way to many close calls both in mine and others practices.
I worry sometimes about how much gets missed in EM. Like you scan someone's T spine because that's where their pain is but oh what the hell you just scan the whole spine and find and epidural abscess. One quik keystroke and the pt would have been dead in 48 hrs. Someone presents for nausea and the voice in the back of your head thinks: "hey this lady is post menopausal, DM, has HTN, and has no PMD. This just might be ACS". You run a trop and its 5.2 . I've seen way to many close calls both in mine and others practices.
Yep, me too. Keeps me awake at night after a really busy shift when I'm doing good to be sure everyone is not overtly dead.
Take care,
Jeff
