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I completed my medical school and background EM training from India (Christian Medical College, Vellore and Apollo Hospitals, Hyderabad) where I worked for 4 years. Following this, I devoted (with all my heart) about 1.5 years to do US Medical Licensing Exams. My stint towards an EM Residency in States did not work but it took me to places and it has been quite a journey. I then relocated to London, England to work as a Registrar (Non-Trainee) in A&E. This gave me an opportunity to better understand NHS, EM training pathways and more importantly the EM Mindsets in the United Kingdom. 

Currently, I am pursuing Higher Specialist Training in Emergency Medicine at South East Scotland Deanery where I have the honour and privilege of training under some of the most innovative brains in the field of Emergency Medicine. Over the past few years, I have realised that LEARNING and UNLEARNING (which can be challenging!) is equally important to deliver cutting edge care to our patients.And through this blog, I aspire to disseminate knowledge, assist trainees with exams and stay up to date with contemporary EM literature. I have always been an avid FOAMed supporter because FOAMed has always played an indispensable role during my training. 


Lakshay Chanana
ST4 EM Trainee 
Edinburgh, Scotland
drlakshayem@gmail.com

Monday, May 2, 2016

Brugada Syndrome: Rapid Review

Introduction

Brugada Syndrome was first described by Pedro and Josep Brugada in 1992 in eight otherwise healthy patients with sudden and aborted cardiac death, in whom they found “right bundle branch block and persistent ST segment elevation in leads V1 to V3”. It’s incidence seems to be particularly high in Southeast Asia where it had been previously described as Sudden Unexplained Nocturnal Death Syndrome (SUNDS), The condition is also believed to be one of the potential causes of sudden infant death syndrome and sudden cardiac death in young children. 

The condition is supposed to be due to a cardiac sodium channel mutation. ECG changes can be transient with Brugada syndrome and can also be unmasked or augmented by severe, schema and medications. 


Check out this short video on Brugada Syndrome, by the legendary "Amal Mattu" 

Different patterns of STE in Brugada Syndrome:

1) Coved: a coved-type (straight or convex upward) terminating in an inverted T-wave, more predictive of arrhythmic events.
2) Saddle: Concave upward



Diagnostic Criteria:

This ECG abnormality must be associated with one of the following clinical criteria to make the diagnosis:



  • Documented ventricular fibrillation or polymorphic ventricular tachycardia
  • Family history of sudden cardiac death at <45 years old 
  • Coved-type ECGs in family members
  • Inducibility of VT with programmed electrical stimulation 
  • Syncope
  • Nocturnal agonal respiration
Definite Treatment

Pharmacological treatment does not protect against recurrent events and implantation of an cardiac defibrillators is the only proven effective treatment in preventing sudden death in patients with the Brugada syndrome.


The term “Brugada Syndrome” is used when the Brugada ECG is accompanied by symptoms of syncope or cardiac arrest.


Take Home



  • Knowledge of Brugada ECG pattern is paramount for Emergency Physicians.
  • Patients with suspected Brugada Syndrome require an early cardiology or electrophysiology opinion. 
  • Definite treatment is implantation of a defibrillator to prevent death from sudden ventricular arrhythmia.  


Further Reading:


  1. http://lifeinthefastlane.com/what-is-brugada-syndrome/
  2. https://www.youtube.com/watch?v=0pbGlhefScg (Part 2)
  3. http://www.medscape.com/viewarticle/828939

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