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Challenges in Clinical Electrocardiography
May 09, 2011

Life-Threatening ST-Segment Elevation Without Coronary Artery Disease—Discussion

Author Affiliations
 

JEFFREYTABASMDPAUL D.VAROSYMDGREGORY M.MARCUSMDNORAGOLDSCHLAGERMD

Arch Intern Med. 2011;171(9):801-803. doi:10.1001/archinternmed.2011.185

After the on-call cardiologist reviewed the ECG and interviewed the patient, plans for coronary angiography were cancelled and consultation with a cardiac electrophysiologist was obtained to confirm the cardiologist's suspicions that this patient's pattern of ST-segment elevation was in fact due to Brugada syndrome and not myocardial infarction. Because of his prior episodes of atypical chest pain, the patient underwent exercise perfusion imaging, which revealed normal left ventricular function and no evidence of ischemia or infarction. A more detailed history revealed a family history of sudden unexplained death in a paternal uncle in his mid-30s. While awaiting sodium channel blockade challenge and possible electrophysiologic testing for type 2 Brugada, serial ECGs were obtained. On the second hospital day, the patient spontaneously assumed a type 1 Brugada pattern (Figure 2), obviating the need for further testing. A single-chamber implantable cardioverter-defibrillator (ICD) was placed without incident.

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