In Reply We thank Drs García-Niebla and Sreenivasan for their interest and knowledgeable comments. The Brugada phenotype is an excellent consideration in this particular patient, especially given the ECG pattern along with rapid correction in the setting of no known risk factors for Brugada syndrome. Unfortunately no testing was performed during the hospitalization to determine if the patient had Brugada syndrome. Although there were many confounding factors in this patient’s presentation, resolution of the ST-segment elevation was seen immediately after correction of hyperkalemia. Therefore, we believe that the severe hyperkalemia is the likely culprit despite the concomitant use of cocaine and amitriptyline.
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Heckle M, Alsafwah S, Agarwal M. Multifactorial Brugada Phenocopy—Reply. JAMA Intern Med. 2018;178(6):873. doi:10.1001/jamainternmed.2018.2019
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