54 Year old man presented after a syncopal event

30/3/2016

This man presented after two syncopal events at home. He describes sudden LOC and woke without any post ictal phase. He has had no episodes of chest pain.

1. What is the diagnosis?
2. How would you manage this man?

10 Comments

4/4/2016 02:45:27 am

1. Brugada
2. Cardio referral (will need at least a telemetry)
- since patient is symptomatic, will need ICD

Naanu Neenu

14/4/2016 11:30:59 am

Type 1 Brugada

Management
Cardiology referral for admission and ICD
Telemetry,
Look for other causes of syncope
Investigate other family members

Naanu Neenu

14/4/2016 11:31:10 am

Type 1 Brugada

Management
Cardiology referral for admission and ICD
Telemetry,
Look for other causes of syncope
Investigate other family members

Andy

14/4/2016 09:42:10 pm

Type 1 Brugada. Patient is symptomatic and hence needs monitored bed till PPM Insertion

Siva

20/4/2016 03:38:40 pm

Brigade unlikely .For type 1 brugada ,need coved st elevation in >1 leads in v1-v3 .In this ecg coved ST appears only on v1.
http://www.csanz.edu.au/documents/guidelines/clinical_practice/Brugada_Syndrome.pdf

22/4/2016 07:05:10 am

the patient has ST elevation in V1 and AVR with T wave flattening in inferior leads. Worry about LMCA or LAD lesion but history not typical for Ischemic event

22/4/2016 07:09:31 am

Correction : actually LMCA artery stenosis can present has syncopal as presenting complain

Zsombor Kovacs

19/5/2016 12:17:11 pm

Pro LMCA stenosis: ST depression and T flattening infero-lateral leads, ST elevation in aVR and V1 only not V2-3
Pro Brugada - V1: PQ prologation, Coved ST segment, T inversion, and obviously the history

Zsombor Kovacs

19/5/2016 12:17:46 pm

DM link

9/11/2016 01:06:25 am

S1,Q3,T3 (neither sensitive or specific)
Inferior-lateral changes, ST elevation in V1>avR
I will stilll include in differential PE

54 Year old man presented after a syncopal event

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