ISSN: 1223-1533

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UNUSUAL CASE OF BRUGADA SYNDROME


Authors: Adelina Mavrea, Ioana Citu, Florina Boran, Raluca Sosdean, Mirela Tomescu




 

Introduction: Sudden death in young people is rare compared with adults, but with a major impact on the community. Causes may include structural or non structural cardiac abnormality. Brugada Syndrome is a serious medical condition that causes sudden cardiac death in apparently healthy individuals.It is 8-10 times more common in men.

 

Case report: A 25-years- old woman, mother of threechildren, the last bornwassix monthsago, no family history of sudden death, had frequent palpitations in the morning and presented in the emergency department. We diagnosed two episodes of ventricular tachycardia with hemodynamic deterioration, requiring electrical defibrillation. After defibrillation, ECG shows aspectof transitory minor right bundle branchblock with ST-elevation and Brugada syndrome is suspected. In evolution, more episodes of nonsustainedpolymorphic ventricular tachycardia occur. Underperfusion with amiodarone, the patient developed QT prolongation with torsade of pointes. We stopped amiodarone and administered I-V magnesium sulfate, with ventricular arrhythmia remission. Beta-blockers were administrated orallyand a cardioverter device was implanted. Echocardiography revealed no structural heart changes. Laboratory testsdid not show any electrolyte and acid-base disorders. To confirm the diagnosis of Brugada syndrome, a test with ajmaline was proposed, which the patient refused. After three days of hospitalization, the QT interval returned to normal value. Genetic tests of the patient and her 1st degree relatives confirmed the diagnosis.

 

Conclusion: We reporta case of recurrent malignant ventricular arrhythmias in a young woman, whowas completely asymptomatic before. Onset of ventricular arrhythmias was similar with Brugada syndrome, followed by the appearance of polymorphic ventricular tachycardia and QT prolongation. Brugada syndrome was diagnosed using genetic tests.