Take Me Out to the Ballgame

A 31-year-old man presented to the ED with syncope. He was previously healthy, takes no medications, and had run a marathon the day before. He was riding the light rail home from a baseball game when he developed vague 4/10 epigastric abdominal pain associated with nausea and diaphoresis. He remembers feeling lightheaded and flushed before momentarily passing out. His wife said he became quite pale immediately beforehand. He did not have any headache, chest pain, or shortness of breath before or after the syncopal episode. He has a significant family history of premature coronary artery disease. He had normal vital signs and a normal physical exam in the ED. A 12-lead electrocardiogram was obtained. The ECG shows sinus rhythm with rSR' pattern in V1 and V2 with borderline prolonged QRS suggestive of incomplete right bundle branch block. Diffuse ST-segment elevation in the precordial leads is suggestive of possible early repolarization or injury pattern. His initial cardiac troponin I was minimally elevated at 0.058 ng/mL. He underwent emergent coronary angiography, which showed normal coronary arteries without significant atherosclerotic changes. Figure 1. His ECG demonstrates a Type 2 Brugada pattern (saddleback ST-T wave with >2 mm ST-elevation), which suggests Brugada syndrome, a cause of cardiac syncope in those without structural heart disease. Chemistry panel and blood counts were unremarkable, but his initial cardiac troponin I was minimally elevated at 0.058 ng/m...
Source: Spontaneous Circulation - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs