JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Fever-Induced Brugada Pattern Misdiagnosed as an Acute Myocardial Infarction David Tadin, MD; Roberto Quintal, MD The Brugada syndrome is a rare condition associated with increased risk of ventricular tachyarrhythmias and sudden cardiac death (SCD). The Brugada pattern on electrocardiogram (EKG) is known to be revealed by several precipitants including febrile illnesses. The appearance of a Brugada pattern on EKG with fever may indicate an elevated risk of arrhythmia or sudden cardiac death. We report a case in which the electrocardiographic abnormality of Brugada pattern induced by sepsis was initially misinterpreted as a ST-segment elevation myocardial infarction (STEMI). The Brugada pattern on EKG resolved with treatment of the underlying sepsis.
99%on roomair,weight of 192kilograms, height of 6 foot 3 inches and body mass index of 53. Pertinent positives on physical exam were mild tenderness to palpation of left upper and left lower quadrants of the abdomen and tachycardia. Pertinent negatives were normal jugular venous pressure, normal lung sounds and cardiac regular rhythm. Pertinent positive labs were blood leukocytosis of 21,000/mm 3 with 3% bands. BUN was elevated at 28 mg/dL and creatinine was elevated at 3.1 mg/dL. (the baseline creatinine was 1.1 mg/dL). His serum bicarbonate level was 16 mEq/L, his TSH was normal, but a mildly elevated FT4 at 1.53 ng/dL was found. The urinalysis was abnormal with positive leukocyte esterase on dipstick. Microscopic analysis showed too many white blood cells to count and many bacteria. Other pertinent lab results were normal troponin, CKMB, CKMB%, but elevated total CPK at 885. BNP was 78 pg/mL. The patient had computed tomography (CT) of the abdomen without contrast that revealed left-sided hydronephrosis and left hydroureter secondary to retroperitoneal fibrosis. The STEMI activation was cancelled and the patient was admitted for sepsis.
CASE REPORT
A 61-year-old manwith a past medical history of hypertension, hypothyroidism, and morbid obesity presented to the emergency department due to profuse diarrhea and headaches. The patient stated that he was in his usual state of health until two days prior to presentation. The patient described 10 watery bowel movements per day. No blood or pus was noted in his stools. His headaches were located over the frontal area and non- radiating. He had associated symptoms of fever and indigestion. He denied chest pain, shortness of breath, palpitations, or edema. During his work up in the emergency department, he had an abnormal electrocardiogram (EKG), different from a prior EKG that prompted a STEMI Team activation (Figures 1,2). The patient had no known family history of cardiac problems including arrhythmias, syncope or sudden cardiac death. Vitals on presentation were: Temperature: 99.1° Fahrenheit, heart rate: 105 beats per min, 20 respirations per minute, pulse oximetry
FIGURE 1: Brugada type I EKG pattern in leads V 1 , V 2 on admission with sepsis.
J La State Med Soc VOL 169 JANUARY/FEBRUARY 2017 11
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