SHM Converge Scientific Abstract ePoster Gallery-Brugadon't Stop the Heart

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This case describes a 36-year-old woman with no significant medical history who presented with nausea, vomiting, and abdominal cramping after eating, initially suggesting a gastrointestinal illness. She was stable on arrival, had a benign abdominal exam, and her symptoms resolved after supportive care. However, during hospitalization she abruptly deteriorated overnight with diaphoresis, tachypnea, hypotension, and recurrent distress.<br /><br />Electrocardiography revealed monomorphic ventricular tachycardia at 240 bpm. She was treated with IV amiodarone and synchronized cardioversion, which restored stability. A repeat ECG showed a Type 1 Brugada pattern, characterized by coved ST-segment elevation in V1-V2. Subsequent workup, including coronary angiography, echocardiography, and cardiac MRI, found no coronary artery disease and no major structural heart disease, though mild cardiomyopathy and reduced LVEF were noted.<br /><br />She was diagnosed with Brugada syndrome, a rare inherited arrhythmogenic disorder associated with ventricular tachyarrhythmias and sudden cardiac death. Management centered on secondary prevention with implantation of an ICD. The case highlights that Brugada syndrome may present unexpectedly and can be triggered or unmasked by physiologic stress, medications, fever, or electrolyte abnormalities.<br /><br />The key lesson is to avoid diagnostic anchoring in young, otherwise healthy patients with apparently benign symptoms, since serious cardiac disease may be hidden behind atypical presentations.

Asset Subtitle

Joyce Ji

Meta Tag

Author List Joyce Ji

Category Clinical Vignettes

Concept Brugada syndrome

Concept Type 1 coved pattern

Concept Ventricular tachyarrhythmia

Concept Cardiac Arrest

Concept Implantable Cardioverter-Defibrillator

Distinguished Non-Finalist

Presenter Organization Washington University School of Medicine

Presenting Author Joyce Ji

Track Adult

Keywords

Brugada syndrome

ventricular tachycardia

sudden cardiac death

Type 1 Brugada pattern

implantable cardioverter defibrillator

arrhythmia

electrocardiography

syncope

cardiomyopathy

cardioversion

Brugada syndrome

Type 1 coved pattern

Ventricular tachyarrhythmia

Cardiac Arrest

Implantable Cardioverter-Defibrillator