Electrocardiographical case. Asymptomatic patient with ST-segment elevation

CK Ching, WS Teo
Correspondence: Dr Teo Wee Siong, teo_wee_siong@nhc.com.sg

ABSTRACT
A 46-year-old man complained of recurrent episodes of giddiness which was not associated with chest pain or breathlessness. There was no family history of sudden death. Clinical examination was unremarkable.12-lead electrocardiogram (ECG) showed ST segment elevation in the right precordial leads, with coved ST segment elevation at its J point followed by a negative T wave with no isoelectric separation, specifically in V2. These ECG features are characteristic of the Brugada syndrome. He underwent a flecanide challenge which produced further elevation of ST segment at its J point and spontaneous ventricular ectopy. Electrophysiological studies induced ventricular fibrillation with 3 extra stimuli. An implantable cardioverter-defibrillator was implanted for prevention of sudden cardiac death. The Brugada syndrome is discussed.

Keywords: Brugada syndrome, cardiac disease, electrophysiological studies, flecanide challenge, ST-segment elevation
Singapore Med J 2004; 45(11): 538-541