Case Study
You are dispatched to a 32-year-old male who experienced a syncopal episode while grocery shopping. Upon arrival, you find an awake, alert, and oriented adult male. He apologizes profusely for disturbing you and tells you he is fine. He denies having chest pain, shortness of breath, or unexplained sweating. He states that he skipped breakfast earlier in the day and had quite a bit of alcohol the night before. You explain the importance of checking his vital signs and blood sugar and he agrees to let you check them. His vital signs are: blood pressure 124/74, pulse 62, respirations 18, SpO2 99%, blood sugar 90 mg/dL. His lung sounds are clear, skin cool, dry and pink, abdomen soft and non-tender. Your partner explains the importance of acquiring an ECG and the patient agrees.
You are dispatched to a 32-year-old male who experienced a syncopal episode while grocery shopping. Upon arrival, you find an awake, alert, and oriented adult male. He apologizes profusely for disturbing you and tells you he is fine. He denies having chest pain, shortness of breath, or unexplained sweating. He states that he skipped breakfast earlier in the day and had quite a bit of alcohol the night before. You explain the importance of checking his vital signs and blood sugar and he agrees to let you check them. His vital signs are: blood pressure 124/74, pulse 62, respirations 18, SpO2 99%, blood sugar 90 mg/dL. His lung sounds are clear, skin cool, dry and pink, abdomen soft and non-tender. Your partner explains the importance of acquiring an ECG and the patient agrees.
12-Lead ECG
§ What
is your interpretation?
§ Do
you see anything life-threatening?
§ What
is your next course of action?
§ Does
this patient need to be transported to the hospital?
Case Study Summary
The ECG reveals a sinus rhythm. There are no signs of chamber enlargement, axis
deviation, or myocardial ischemia. Close inspection of leads V1-V2 reveals an incomplete right bundle branch
block (rSR’ pattern), ST segment elevation, and T wave inversion, consistent
with Brugada Syndrome.
Brugada
Syndrome is a genetic condition involving a sodium channel abnormality in the
heart’s cells. The disease causes ventricular tachydysrhythmias that may lead
to syncope or sudden death. The disease primarily affects males and is most
commonly discovered in the third or fourth decade of life. Brugada Syndrome is
reported to cause 5% of all sudden cardiac arrest cases.
This
patient should be transported to the emergency department for further
evaluation. Treatment for Brugada Syndrome includes electrophysiologic testing
and placement of an automated implantable cardioverter-defibrillator.
Clinical Pearls
§ Never
dismiss syncope in the prehospital setting.
§ Acquire
a 12-Lead ECG on all patients presenting with presyncope or syncope and
scrutinize the tracing for changes consistent with life-threatening diseases.
§ Brugada
Syndrome is characterized by:
§ An
incomplete right bundle branch block (rSR’ pattern in leads V1-V2).
§ ST
segment elevation in leads V1-V2.
§ T
wave inversion in leads V1-V2.
Suggested Readings
Syncope–http://emedicine.medscape.com/article/811669-overview
Brugada Syndrome–http://emedicine.medscape.com/article/163751-overview
