Hyperthermia and ST Elevation

DiscussionBrugada Type 1 ECG changes are associated with sudden cardiac death (SCD) and the occurrence of ventricular dysrhythmias. Patients that develop a Type 1 pattern without any precipitating or provoking factors have a risk of SCD of 0.5-0.8% per year. In patients that only have this pattern induced by a sodium channel blocking agent have a lower rate of SCD (0 - 0.35% per year)[1]. Drugs that have been associated with Brugada ECG patterns include tricyclic antidepressants, anesthetics,cocaine, methadone, antihistamines, electrolyte derangements, and even tramadol. [2]. Our patient had a Brugada Type 1 pattern elicited by an elevated core temperature, which is also a documented phenomenon. She was on amitriptyline 50 mg/day but no other medications that would affect the sodium channel. There are many case reports of ST elevation with Brugada pattern related to fevers related to infections [3, 4]. It is hypothesized that the rate of sodium channel inactivation can be temperature sensitive and that fever can impair the conductance through the sodium channels [5, 6]. In the largest study looking at this topic by Mizusawa et al., 88 patients with fever induced Brugada Type 1 ECG changes without history of syncope or VF/VT were analyzed. There was a 0.9% per year incidence of SCD in this cohort [1]. Prior to Mizusawa ' s study, it was thought that the incidence of syncope, arrhythmia, or SCD in this cohort was low [7]. Of those that had fever induced Type 1 pa...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs