Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?

A 30-something male was involved in a single vehicle crash and had multiple injuries. As a routine part of his critical trauma evaluation, he had an ECG recorded:There is an rSR " in V1 and V2, with downsloping ST segment and inverted T-wave which is very similar to a Brugada Type 1 phenocopy.  I was shown this ECG and thought that it could perhaps be Brugada, butI was more suspicious for Right Ventricular (RV) myocardial contusion. The RV is the most anterior part of the chest and is most likely to be contused with anterior chest trauma.  Moreover, this degree of ST Elevation is very unusual for Brugada.On the other hand, the accident was unexplained.  Did the patient have an episode of VT due to Brugada, and lose consciousness while driving?Here is one slice of the patient ' s chest CTNote the pneumothorax, but the pneumothorax underlies leads V3-V5, not V1 and V2.  On the other hand, the RV lies directly under leads V1 and V2; this makes pneumothorax less likely as an etiology of the abnormal ECG.The pneumothorax was expanded with a chest tubeAt 17 hours, another ECG was recorded:It is now much less dramatic and has the morphology ofType 2 BrugadaThe hs troponin I peaked at 6500 ng/L-- this strongly suggestsmyocardial contusion. Is there also Brugada?An echocardiogram was done.  Here is the result:The estimated left ventricular ejection fraction is 50 %.There is no left ventricular wall motion abnormality identified.Ri...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs