young person collapse

by Adam Herbstritt

​38 year old female.
Out of hospital arrest. Paramedics on scene within minutes and shocked VF 3 times to ROSC.
Intubated in ED for cerebral agitation.

Whats your ECG differential for young person collapse?

Now interpret his.

Sinus 78reg, normal axis. ST elevation V1-3 with inter ventricular delay QRS 115ms.

This is consistent with Brugada syndrome.  Along with WPW, HOCM, and long QT syndrome its a 'collapse' ECG finding we should all be looking out for.  There is a high association with sudden death.   Patients have structurally normal hearts but a mutation in the cardiac sodium channel gene. Interestingly there has been reported benefit from interim sodium bicarb if repeated shocks fail to cardiovert in Brugada - perhaps working similarly to its use in sodium blocking ODs like Tricyclics.

Patients need an implanted defib. Diagnosis depends on a characteristic ECG finding AND clinical criteria. (Brugada sign in isolation is of questionable significance).

There are 3 types...but just think STe V1-3 with slight QRS widening. (images from LITFL)

The patient had a normal angio and an ICD was sited on day 3. She was discharged without neuro deficit.

Comments welcomed!